Is Mike Johnson really telling Trump what to do on health care policy? Probably not.
Photo: Andrew Harnik/Getty Images
There was an enormous hullabaloo in Washington over the weekend when reports surfaced that Donald Trump was about to unveil a health-care deal without much in the way of advance consultation with his congressional Republican vassals. According to multiple accounts, the plan would include a two-year extension of the enhanced Obamacare premium subsidies due to expire at the end of the year with new (and fairly minor) eligibility limits and a “skin in the game” requirement of minimum premium payments. There would have also been some sort of Health Savings Account option in a gesture to conservatives who want to get rid of health insurance and encourage people to pay health-care providers directly. But by and large, the proposal as presented was very much along the lines of what was being discussed behind the scenes by both Republican and Democratic senators and was politically feasible, recognizing that some lawmakers in both parties won’t support any deal at all.
But Monday came and went without the expected presidential announcement, and next thing you knew Trump was headed to Mar-a-Lago for Thanksgiving. It’s possible that the rollout of what would have inevitably been labeled “Trumpcare” was simply delayed until next week. But all along, the prospects of a presidentially brokered health-care deal depended on speed, stealth, and a my-way-or-the-highway declaration from Trump that his plan had to be backed by virtually every congressional Republican, much like his One Big Beautiful Bill Act. It sure looked like that sort of Trump blitz was in the works, until it wasn’t.
According to The Wall Street Journal, the mouse that roared in putting a hold on Trumpcare 2025 was none other than House Speaker Mike Johnson:
Speaker Mike Johnson (R., La.) cautioned the White House that most House Republicans don’t have an appetite for extending enhanced Affordable Care Act subsidies, according to people familiar with the matter, showing how hard it will be politically to stave off sharp increases in healthcare costs next year for many Americans.
The message from Johnson, in a phone call with administration officials, came as President Trump’s advisers were drafting a healthcare plan that extended the subsidies for two years.
The warning underscores the hurdles facing any deal in coming weeks.
The narrative all but writes itself: House Republicans, emboldened by their successful defiance of Trump over the Epstein Files Transparency Act, are refusing to take orders from Trump to bless the signature health-care initiative of the much-despised 44th president. And instead of going into a hate-rage and ordering purges, the newly chastened 47th president is going back to the drawing board.
That’s one interpretation of what’s happening. Another is that this version of “Trumpcare” is largely a feint — or to be less charitable, a scam. The only reason Republicans have even considered an Obamacare-subsidy extension deal is that the huge premium spike on tap if nothing is done could become a big issue in midterm elections already prospectively dominated by affordability concerns. They could have nestled an extension into the OBBBA but didn’t, which is a pretty clear indication of their underlying wishes. But for purposes of midterm “messaging,” lofting trial balloons and agitating the air over health-care costs is nearly as valuable as actually doing something about the problem. It’s possible that’s what Trump is doing before he manages to blame the failure to act on the Radical Left Democrats.
Even if Trump is serious about the issue and has a come-to-Jesus meeting with the allegedly rebellious Mike Johnson to force support for a Trumpcare proposal, there’s a very convenient poison pill he could put into the mix to sabotage any actual deal that might divide his own party. Despite safeguards placed in the original Affordable Care Act to ensure no direct federal payments for abortion services, the anti-abortion lobby has long demanded more extensive prohibitions to make sure states don’t pony up the money to provide abortion coverage in Obamacare policies. The debate over the extension of subsidies provides a fresh opportunity for these people — who have felt marginalized ever since Donald Trump rejected their call for a national abortion ban — to prove they are still an indispensable element of the GOP/MAGA coalition. Senate Majority Leader John Thune, who has promised Democrats a vote on Obamacare-subsidy extensions by mid-December, is also on record demanding tighter restrictions on abortion coverage. Rejecting such restrictions is a red line for many Democrats, who will already be under pressure to make minimal concessions to the GOP on an issue that could otherwise represent midterm dynamite for the opposition party.
So perhaps Congress and the White House are significantly farther away from a health-care deal than it appeared just yesterday. But let’s not credit Mike Johnson for too much courage or clout. If Trump really wants a health-care deal based on Obamacare-subsidy extensions with the conservative bells and whistles, he can get it with the appropriate ham-handed ultimatums combined with take-it-or-leave-it blandishments to Democrats. He really ought to do so, because health-care costs aren’t going away as an issue and Trump has no better plan for coping with them than he did when he took office in 2017 and “Trumpcare” became a joke.
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