President Trump’s germinal proposal to extend ObamaCare subsidies has created new headaches for GOP leaders on Capitol Hill. 

Since 2010, when the Affordable Care Act (ACA) was enacted by former President Obama, Republicans have hammered the law as a government takeover of the nation’s health care system that’s eroded patient liberties and undermined the quality of care while increasing costs for individuals and exploding deficit spending.

Trump’s plan, which multiple outlets reported features a two-year extension of soon-to-expire ACA tax credits paired with eligibility limits, contradicts those Republican criticisms, including attacks by Trump himself earlier in the month.

And it could set the stage for GOP leaders in Congress to advance a program they deeply detest after warning for months of its harmful effects.

Speaker Mike Johnson (R-La.) has led the ObamaCare opposition on Capitol Hill, arguing the program is irredeemable and needs a massive overhaul, if not outright repeal.

He and Senate Majority Leader John Thune (R-S.D.) had refused to negotiate on the Democrats’ demand to extend the ObamaCare subsidies during last month’s fight over government spending — an impasse that led directly to the 43-day shutdown. While Thune promised Senate Democrats a mid-December vote on extending the subsidies, Johnson notably declined to make any such commitment.

Those subsidies expire Jan. 1, however, threatening to spike health care costs for roughly 22 million Americans who currently benefit from them.

The deadline has put Republican leaders into a no-win position: If they extend the tax credits, they’ll go on record for the first time augmenting a Democratic law they deem noxious while infuriating a conservative base that’s spent more than 15 years trying to kill it. 

If they don’t, the out-of-pocket health costs for millions of people will skyrocket heading into next year’s midterm elections, when Republicans are already at risk of losing control of the House.

The tensions are strong enough that the White House — faced with a conservative outcry — reportedly scrapped its plans to unveil the subsidy extension Monday. 

“Hoping this isn’t true,” Rep. Bob Onder (R-Mo.), a former physician, posted Monday on the social platform X in response to reports of the plan.

GOP centrists, however, are hoping it’s only a delay, not a cancellation. They’re warning that congressional inaction would spell doom for Republicans at the polls next November, urging GOP lawmakers to hold their noses and prevent the cost cliff, even if it flouts their ideological sensibilities.

“The politics of this are not a close call. With the House hanging by a thread, it is clearly in the interest of Republicans in Congress to avoid this crisis,” Brendan Buck, a former House GOP leadership aide, said Monday in an email. “Sometimes protecting the majority may mean disappointing some other members, but as a political calculation, it’s pretty straightforward. I also don’t imagine this story is over yet.”

Trump’s nascent health care plan reportedly features a two-year extension of the enhanced ACA subsidies, which were expanded and increased by the Biden administration in 2022, during the COVID-19 pandemic. In a nod to the conservative critics, the president’s blueprint would also install new limits on benefits, including an eligibility cap on income of 700 percent of the federal poverty level. In addition, it would require all beneficiaries to assume some premium costs — a response to conservative concerns that zero-premium plans encourage fraud.

White House press secretary Karoline Leavitt declined to weigh in on the specifics of the plan, but confirmed Trump is directly involved in the conversations. 

“Health care is a topic of discussion that’s happening very frequently and robustly inside the West Wing right now. The president is very much involved in these talks, and he’s very focused on unveiling a health care proposal that will fix the system and will bring down costs for consumers,” Leavitt told reporters Monday. 

“As for the details of those discussions, I’ll let the president speak for himself.” 

The proposal, if it emerges, would mark a sharp reversal from Trump’s position just a few weeks ago, when he was bashing the ACA subsidies as a boondoggle enriching insurance companies at the taxpayers’ expense.

“The only healthcare I will support or approve is sending the money directly back to the people, with nothing going to the big, fat, rich insurance companies, who have made $trillions, and ripped off America long enough,” Trump posted on Truth Social at the start of the month. “The people will be allowed to negotiate and buy their own, much better, insurance. Power to the People.”

Trump’s apparent reversal, however, has done little to appease his Democratic critics in the Capitol, who wasted no time bashing the reported details of the plan with warnings that the new benefit limits would crush millions of Americans already struggling in a volatile economy.

“The White House’s new scheme to gut the expanded ACA premium tax credits is nothing more than the greatest hits of Republican health care ideas the people have rejected for years—hiking costs on families, pushing skimpier coverage, penalizing people who get sick, and expanding tax shelters for the wealthy,” Reps. Richard Neal (D-Mass.), Frank Pallone (D-N.J.) and Bobby Scott (D-Va.) said Monday in a joint statement. 

Not all Democrats, however, were so critical. 

Sen. Jeanne Shaheen, a New Hampshire Democrat who had broken with her party leadership to help reopen the government earlier in the month, said she’s hoping Trump’s plan — and his outsized influence over his party — will help Congress come to an agreement after weeks of partisan bickering. 

“If the reports are true and the President is considering coming to the table in good faith, I believe we can find a path forward that can earn broad bipartisan support in Congress,” Shaheen said. 

Even some conservatives hailed Trump for putting a plan out there and getting the conversation started. 

“We’ve got to quit pointing fingers, we’ve got to start doing something with this thing. At least Trump’s proposal does something. … It keeps people from losing their insurance and it verifies that it’s not a bunch of frauds,” Rep. Tim Burchett (R-Tenn.) posted Monday on X.

“I think it’s something we ought to be looking at,” he added, “but we probably won’t.” 

Nathaniel Weixel and Brett Samuels contributed.