For now, Democrats are resisting and using his maneuver against him to energize their own party. And they warn that Mr. Trump will be blamed if the insurance markets collapse and people lose coverage next year.
“Republicans are in control of government,” Senator Claire McCaskill, Democrat of Missouri, said Thursday after a town-hall-style meeting in her home state. “If they blow up what access to health care there is right now, they’re going to own it.”
The president’s tone differs from that of Republicans in Congress, who have repeatedly promised a smooth transition away from the law they call Obamacare. “We don’t want to pull the rug out from under people,” the House speaker, Paul D. Ryan, has said.
If the subsidies are interrupted, insurers say, some health plans will increase premiums and others will withdraw from the individual insurance market. That will, in turn, affect millions of other people who do not receive the subsidies.
The issue could come to a head within weeks. When the House reconvenes on April 25, the first order of business will be a spending bill to replace the current stopgap law, which expires three days later. Democrats are determined to put money for the health insurance subsidies into that bill, and some Republicans on the House and Senate Appropriations Committees are open to the idea. But ultimately, the decision will be made by Republican leaders in the two chambers.
If the spending is allowed to continue, the Congressional Budget Office estimates that the federal government will pay $135 billion in cost-sharing subsidies to insurers from 2018 to 2027.
The cloud of uncertainty swirling around the subsidies stems from a court ruling in a lawsuit that House Republicans filed against the Obama administration in 2014. Judge Rosemary M. Collyer of the Federal District Court in Washington ruled last year that spending on the subsidies “violates the Constitution” because Congress never appropriated money for them. She ordered a halt to the payments, but suspended her order to allow the government to appeal.
The Trump administration has not made clear whether it will press the appeal filed by the Obama administration. In a letter to Mr. Trump this week, the U.S. Chamber of Commerce joined the American Medical Association, the American Hospital Association and insurers in seeking “quick action” to guarantee continuation of the subsidies. Without the subsidies, they said, more people will be uninsured and unable to pay medical bills.
Democrats say they will not negotiate with Mr. Trump until he stops his drive to repeal the Affordable Care Act. “President Trump is threatening to hold hostage health care for millions of Americans, many of whom voted for him, to achieve a political goal of repeal that would take health care away from millions more,” said the Senate Democratic leader, Chuck Schumer of New York.
Having no immediate prospect of a deal with Democrats, the White House is still focusing on Republicans. It is seeking consensus on a repeal bill that can overcome rifts among House Republicans, whose disagreements sank an earlier version of the legislation on March 24.
Even though lawmakers are out of town for a two-week spring break, Mr. Trump and Vice President Mike Pence are continuing efforts to revive the bill in talks with Representative Mark Meadows, the North Carolina Republican who is the chairman of the conservative House Freedom Caucus.
Many conservatives opposed the earlier version of the bill, saying it did not do enough to repeal federal rules that drive up the cost of insurance. Democrats say those rules, including a definition of minimum benefits, provide essential protections for consumers.
Asked about the outlook for a deal, Sean Spicer, the White House press secretary, said Tuesday, “I think we’re getting closer and closer every day.” But potential gains among conservatives risk alienating moderate Republicans.
Representative Justin Amash, Republican of Michigan and a member of the Freedom Caucus, said at a town hall-style meeting this week that 50 to 80 Republicans would have voted against the bill that was pulled from the House floor last month.
Mr. Amash had a suggestion for the administration and House leaders. “Let’s start over in a bipartisan way,” he said. “We should have worked with Democrats from the very beginning. At the end of the day, you cannot pass legislation, whether it’s the A.C.A. or a new health care proposal, that affects so many people and not have it be bipartisan.”
The Trump administration announced rule changes on Thursday that it said would help stabilize insurance markets and reduce premiums. The new rules would cut the annual open enrollment period in half, so it would run from Nov. 1 through Dec. 15 this year. If consumers wanted to sign up at other times, they would have to submit documents to prove they were eligible for a “special enrollment period.”
Marilyn B. Tavenner, the chief executive of America’s Health Insurance Plans, a lobby for insurers, welcomed the changes but said they were not enough.
“Most urgently,” she said, “health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted. Without funding, millions of Americans who buy their own plan will be harmed. Many plans will likely drop out of the market. Premiums will go up sharply — nearly 20 percent — across the market.”
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