It?s the Trump ship that never sails.

The president was back at it on Monday, promising an imminent solution to America?s growing health care crisis ? on which he has repeatedly failed to deliver in the past.

?I tell you, we?re going to be working on that very hard over the next short period of time, where the people get the money,? President Donald Trump said, referring specifically to Americans thrown into crisis by expiring enhanced Affordable Care Act subsidies. ?We?re talking about trillions and trillions of dollars, where the people get the money,? he added, without giving details about a vague idea to send cash to affected policyholders to replace subsidies while bypassing insurance firms.

Trump?s off-the-cuff answer was a typical example of the waffle he sometimes conjures to escape a jam in a photo-op. But he could not disguise the downside of his ?win? in the government shutdown, which looks set to end after Democrats failed to secure their top demand: the extension of those enhanced Obamacare subsidies.

Trump and Republicans once again own the issue of health care, with millions of citizens ? not just those on ACA plans ? afflicted by rising premiums and high deductibles against the backdrop of a wider cost-of-living crisis. And just as in his first term, Trump lacks a comprehensive, detailed plan to bring relief to citizens who lack health care, who can?t afford the plans they have or who know that the loss of a job could leave them without any coverage at all.

If the GOP cannot fix the immediate issue of the subsidies ? and convince voters they have a serious solution to this and other affordability questions ? their 2026 midterm election hopes could take a dive.

Trump?s fogginess on health care is nothing new. Repeated unfulfilled promises to act took their place alongside his much-lampooned ?infrastructure weeks? as punch lines in his first term. Trump?s pledges to replace Obamacare shimmered with hyperbole but delivered nothing, and the 2010 law survives despite multiple Republican efforts to destroy it.

Republican divisions boil over health care

The fight over health care was not just at the center of the government shutdown battle with Democrats. It?s tearing at Republican Party unity. It?s even estranged Trump and one of his most outspoken supporters, Marjorie Taylor Greene. The Georgia representative broke ranks early in the shutdown to highlight ACA insurance premiums for her family that she said would double in price due to expiring subsidies. While no fan of the ACA, she lashed out at her own party. ?Not a single Republican in leadership talked to us about this or has given us a plan to help Americans deal with their health insurance premiums DOUBLING!!!? Greene wrote on X in October.

Greene?s persistent criticism is a warning sign for House Speaker Mike Johnson after he called back the House to vote on the Senate plan to reopen the government this week. It might explain why he was so keen to keep the chamber dark during a shutdown that set internal GOP dissent simmering. Greene further distanced herself from Trump on Monday, saying on X that he should spend less time meeting foreign leaders and instead hold ?nonstop? meetings on domestic policy.

The president told CNN?s Kaitlan Collins, ?I don?t know what happened to Marjorie. She?s a nice woman, but I don?t know what happened. She?s lost her way, I think.? Greene then told CNN, ?I haven?t lost my way. I?m 100% America first and only!?

Greene might now be regarded as a MAGA heretic by some in Trump?s orbit. But her comments on health care raise another possibility ? that she?s far more in tune with the economic insecurity felt by regular Americans than a billionaire president and his wealthy Cabinet.

During the 2016 campaign, Trump pledged to repeal Obamacare and replace it with something ?terrific.? At rallies, he promised Americans new health care that would cost less but be far better. If that sounds impossible, it?s probably because it is.

Early in his first term, Trump promised that change was on the way. ?Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!? he wrote on the website formerly known as Twitter in March 2017. The GOP failure to repeal Obamacare, partly because it couldn?t come up with an alternative, didn?t stop Trump?s sunny predictions. ?The Republican Party will be soon be known as theparty of health care,? the president declared in March 2019.

Second term, same as the first. In his debate with Democratic nominee Kamala Harris in 2024, Trump was mocked for saying he had ?concepts of a plan? to make health care ?better and less expensive.? More than a year later ? and despite some significant efforts by Trump to bring down the cost of some prescription drugs ? Americans are still waiting for his wider solutions.

She?s not alone. During the shutdown, a group of endangered House Republicans wrote to Johnson to urge him to address expiring enhanced ACA subsidies when the government reopens. ?While we did not create this crisis, we now have both the responsibility and the opportunity to address it,? they wrote.

Senate Republican leader John Thune agreed to hold a vote in December on extending enhanced Obamacare subsidies as part of the deal with moderate Democrats to reopen the government. Chances of a Democrat-written bill passing are slim. But the vote will put GOP senators on the record and on a political spot.

Johnson hasn?t pledged to hold a similar vote ? one reason why progressive Democrats are angry about centrist Senate Democrats? compromise to end the shutdown.

The speaker told CNN?s Jake Tapper on ?The Lead? Monday that he?d always been willing to talk about rising health care costs, but that Democrats had squandered weeks of valuable time by triggering the shutdown last month. He promised debate on a plan to get to the ?root cause? of the health care issue. But that is unlikely to help ACA policyholders forced to decide now whether to give up health plans they can?t afford or pay punitively rising premiums.

Johnson could not tell Tapper whether there?d be a vote on this issue soon. ?I?m not committing to it or not committing to it. What I?m saying is that we do a deliberative process. It?s the way this always works and we have to have time to do that,? the speaker said. But the tiny GOP majority gives little cause for optimism that an issue as complex and divisive as health care reform is something the fractious GOP and an absent president could handle.

One tangible gain for Democrats in the shutdown drama was their highlighting of the ACA issue and attacks on Republicans for failing to fix health care. In an NBC News poll taken last month during the shutdown, 10% of respondents cited the cost of health care premiums as the single top issue deciding their vote for Congress next year. And 49% of respondents said Democrats would do a better job dealing with health care compared with 26% who thought the same of Republicans

Many Democrats are furious that their moderate Senate colleagues made a deal with Republicans to reopen the government because they see it as a betrayal of Americans on the health care issue. But Sen. Jeanne Shaheen, who helped broker the deal and joined seven others in the Democratic caucus to back it, told CNN?s Kate Bolduan the deal would show whether Republicans were serious.

?Finally, because of the shutdown fight, we?ve had a number of Republicans who have figured out that this is an issue for them,? the New Hampshire Democrat said. ?So, now we?ll see. We?ll see if they are really going to work with us to make sure that Americans can afford their health insurance.?

Viewing Democratic tactics, a cynic might wonder whether the party, which failed to make the enhanced Obamacare credits permanent during the Biden administration, laid a trap for Republicans on an issue their rivals always failed to solve, especially under Trump.

But some Republicans don?t buy the idea that the party is vulnerable on health care, arguing that Democrats would be blamed for higher costs. GOP Sen. Eric Schmitt told CNN that ?I think people know that Democrats own Obamacare, and it?s been a disaster.?

How Trump has tried to lower some health care costs

Republicans argue that Trump?s ?One Big Beautiful Bill? domestic policy law had already made significant steps to make health care more affordable by loosening the power of insurance companies and by restoring choice and control, partly by handing more responsibility to the states. But multiple health care analysts and groups say that the bill?s cuts to Medicaid funding could leave millions vulnerable to losing coverage and threaten many rural hospitals with closure.

The administration has several initiatives designed to reduce the costs of prescription drugs for Americans. It plans to launch TrumpRx, a direct-to-consumer website, early next year. Last week, the president unveiled a plan to make certain obesity drugs available for as little as $149 in an arrangement that gives pharmaceutical firms like Eli Lilly and Novo Nordisk tariff breaks. If this plan works, it could be lifesaving for many patients who can?t get the drugs through their insurers and can?t afford out-of-pocket prices to buy them.

The initiative reflects Trump?s willingness to use government power to intervene in markets, which has also been seen in other sectors, and which flies in the face of conservative orthodoxy. A plan he recently floated to send money directly to ACA policyholders, instead of offering subsidies, also seems to spring from a similar motivation to shake up the industry.

Yet the idea is fraught with uncertainties, including whether such payments would cover the shortfall of all the subsidies. Another question is whether it would simply make up the shortfall in subsidies to pay for premiums. Or would it be a separate payment that patients could use to pay for the costs of treatment directly?

In the latter case of a payment that bypasses insurance firms, recipients might be exposed to massive costs if they get an adverse diagnosis. Trump told Fox News on Monday evening that he didn?t want money to go to insurance companies but that it would go into a separate account so people could negotiate their own, better health insurance.

?They?re going to feel like entrepreneurs,? Trump said. But he gave no details of how such a complex scheme could help policyholders now, and did not explain how it would lower costs.

And spiking health costs don?t only afflict ACA policyholders. If the government sent cash to certain Americans, how would that be fair to other taxpayers? And wouldn?t state-financed payments for health care go against everything the GOP believes?

Such thorny questions, and the president?s past failures to deliver on health care, explain the Republican Party?s new but familiar political nightmare on an issue that causes anxiety for tens of millions of voters (CNN)

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