Trump Wants A Health Care Deal. He’s Leaving The Details To Congress.

The White House is providing congressional Republicans with few specific demands on what kind of health care legislation President Donald Trump might support, giving some Republicans heartburn about how they will prevent a dramatic spike in some health premiums next month.

Republican lawmakers crafting legislation to address the subsidy cliff, however, say they are regularly in touch with the White House and focused on getting a plan that could reach the president’s desk — requiring consensus among their own party and the Democrats needed to get a bill through the Senate.

"Nobody has said 'this is how it's got to be,’” Senate Finance Chair Mike Crapo (R-Idaho), who is leading the effort to draft health care legislation, said about the White House’s input. He described the White House as generally “engaged,” without giving red lines.

Senate HELP Committee Chair Bill Cassidy (R-La.), who is co-piloting the effort, said they’re “totally in line” with the president’s public comments on health care reforms.

“Right now, we got to get 60 votes,” Cassidy said. “I got to get my Republicans, and I got to get my Democrats. And so that's my challenge.”

Asked what specific guidelines the White House has outlined, Cassidy said only that he hasn’t gotten “any negative feedback on what we’re doing” or heard any concerns from the White House over Trump’s willingness to ultimately sign on.

Rep. Brian Fitzpatrick (R-Pa.), the co-chair of the House's Problem Solvers Caucus, said the White House has given him “broad parameters” as he’s worked to craft another bill in the House that would include health savings accounts along with extended subsidies with income caps and other restrictions.

"It's always good if the White House gives a green light – they have to sign it ... but we're just trying to thread a needle to get to 218 and 60,” Fitzpatrick said Wednesday, adding that if people are “waiting for, you know, either the Senate or the White House to act, I think we're going to be waiting.”

Other GOP lawmakers, however, want more input from Trump to help drive the GOP’s various factions.

“I think it would be helpful to get things into the funnel. The White House clearly believes that we need to have a solution, I think it would be very helpful for them to weigh in,” retiring Sen. Thom Tillis (R-N.C.) said Wednesday.

Trump has given limited direction on the health care details Republicans need to address, but has been explicit on one policy tenet: he wants enhanced Affordable Care Act subsidy funds redirected into health savings accounts that Americans can use for out-of-pocket costs.

It’s unclear whether Trump would approve extending the subsidies as part of a broader deal. A White House plan that leaked last month called for a two-year extension. But Trump last week said he did not want toextend the subsidies unless it was necessary to get a deal on health savings accounts across the finish line.

A White House official granted anonymity to discuss internal matters said the administration is working with Congress “to deliver meaningful solutions that lower healthcare costs for everyday Americans,” and added that any specific policy announcements “will come directly from President Trump.”

The lack of direction has left Republicans with multiple, and in some cases competing, efforts. Many Republicans are eager to avoid a repeat of the 2017 failed effort to repeal and replace the Affordable Care Act, an exercise that some GOP lawmakers jokingly acknowledged this week gives them legislative PTSD.

Sen. John Cornyn (R-Texas), who was the No. 2 Senate Republican at the time, didn't directly weigh in on the White House but quipped about the party’s perennial healthcare headache: "Republicans have always had trouble coalescing around an alternative, you might have noticed.”

Some Republicans also worry it’s risky to drive forward a plan without a concrete framework from the White House, because Trump could back another idea at the 11th hour.

“The White House, what they think about the ACA, I think it has been a very big question mark,” said a GOP aide granted anonymity to discuss internal deliberations. “It's helpful, in general, to know where the White House is on anything. He's gonna have to sign any of these bills into law.”

Two other GOP aides, also granted anonymity to discuss internal dynamics, acknowledged that while there have been a lot of discussions between the two ends of Pennsylvania Avenue, Republicans have gotten little guidance about what the White House wants to see.

They’re up against somewhat of a Dec. 11 deadline. That’s when the Senate is expected to hold a vote on legislation related to the expiring subsidies — part of the deal Senate Majority Leader John Thune (R-S.D.) struck to end the government shutdown, which Democrats used to highlight the imminent insurance cost increases.

Democrats are expected to put forward a three-year clean extension of the Obamacare tax credits, but it’s unclear if Republicans will be ready to put forward their alternative proposal by then.

Earlier this week, Thune described ongoing “discussions” with the White House on health care, but said the administration isn’t “advocating for trying to advance anything at the moment.”

“Some of our folks who are working on this issue are trying to come up with something that unites Senate Republicans,” Thune said Wednesday, adding that there are “consultations going on all the time with the White House.”

The other Republicans who have circulated ideas and proposals, including Sens. Markwayne Mullin of Oklahoma, Josh Hawley of Missouri and Rick Scott of Florida, say they’ve spoken with the White House.

Mullin, a close Trump ally, said he spoke with the president about health care last week but was unclear whether Trump would publicly lay out what he wants to see in a plan ahead of the Senate vote. Hawley also pitched Trump last month on his proposal to make it easier for more taxpayers to deduct medical expenses.

Scott, who has his own plan on health savings accounts, defended the White House’s lack of a definitive framework and its deference to the Hill.

“I think they're letting Congress do its job, which I think is appropriate,” Scott said. Should the president ultimately dislike what the Hill produces? “That's his right.”