• Former President Donald Trump has proposed sending direct cash payments to Americans for purchasing private insurance as an alternative to the Affordable Care Act
  • The preliminary proposal lacks formal backing from Senate Republicans and comes amid a government shutdown that began October 1
  • Millions of Americans face potential premium increases if expiring COVID-19-era subsidies aren't extended, creating urgency for congressional action

Former President Donald Trump is considering a health care proposal that would send direct cash payments to Americans to purchase private insurance, according to economic adviser Kevin Hassett, though the plan remains in early stages without formal Republican Senate support.

The proposal emerges as Congress grapples with a federal government shutdown that began October 1 and the impending expiration of pandemic-era premium tax credits that have helped millions afford health coverage. Without congressional action, these subsidies will lapse, potentially causing premium spikes for vulnerable Americans.

"The proposal is still preliminary and hasn't been endorsed by our Senate colleagues," Hassett acknowledged, speaking about the internal discussions. He emphasized that the direct payment approach would route subsidies to consumers rather than insurers, potentially increasing market competition.

Republican senators have expressed openness to extending some expiring subsidies but want new eligibility limits, according to people familiar with the negotiations. The internal party debate reflects broader tensions about how to address health care costs while moving away from the Affordable Care Act framework.

Trump has urged Republican leadership to scrap the legislative filibuster to expedite health care reform, but Senate leaders have so far declined to take that step. Vice President JD Vance has aligned with Trump, advocating for rule changes to bypass Democratic obstruction.

Meanwhile, bipartisan negotiations continue in the Senate, with moderate senators seeking a compromise that would restore government funding while addressing the subsidy expiration. House Speaker Mike Johnson has declined to pledge a health care vote as part of any broader deal, creating additional uncertainty.

The situation has created anxiety for insurers, state officials, and consumers who face potential coverage disruptions if subsidies expire without replacement. Several states are preparing contingency plans for millions who might lose support if federal negotiations collapse.

Senators from both parties have addressed the urgency on the Senate floor this week, indicating the heightened political stakes. A Senate vote on a bipartisan compromise could occur within days, though the outcome remains uncertain.

Correction: An earlier version of this article misstated the status of Senate negotiations. The direct cash proposal remains preliminary and lacks formal Republican support.