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Trump Pulls Back From Senate Deal to Fund Health Subsidies

Republicans in Congress have hardly rushed to embrace the deal, but it has won endorsements from a handful of Republican senators, including Susan Collins of Maine, Bob Corker of Tennessee, John McCain of Arizona and Lisa Murkowski of Alaska.

“Congress has a responsibility to ensure that families in Tennessee and across our country who receive health insurance through the individual market do not continue to be burdened with rising premiums and fewer choices,” Mr. Corker said.

And an unavoidable fiscal deadline this year still offers an opportunity for lawmakers to demand that the subsidies be funded, regardless of the president’s position. Lawmakers need to pass a funding measure to keep the government open beyond Dec. 8, and no bill can pass without Democratic votes.

At that point, supporters of the Alexander-Murray measure could insist on its inclusion in any spending bill and threaten to shut down the government if they do not prevail. If Republican leaders relent, Mr. Trump’s veto of the health measure would effectively shutter the government.


Senator Chuck Schumer, the Democratic leader, on Tuesday in Washington.

Al Drago for The New York Times

Still, the uncertainty around the legislation grew on Wednesday. Speaker Paul D. Ryan of Wisconsin, reflecting his most conservative members, came out against the deal.

“The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” said Doug Andres, a spokesman for Mr. Ryan.

And the Senate Democratic leader, Chuck Schumer of New York, expressed frustration over a president who “keeps zigging and zagging, so it’s impossible to govern.”


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“You never know from hour to hour what he thinks,” Mr. Schumer said.

Senator John Thune of South Dakota, the third-ranking Senate Republican, had predicted on Tuesday that Congress would “move fairly quickly” on the bipartisan proposal, but he revised that forecast on Wednesday. For now, he said, the plan has “stalled out.”

“We’re kind of in a holding pattern,” he said, as Mr. Alexander tries to convince the president that the deal would benefit consumers, not insurance companies.

Senator Orrin G. Hatch of Utah, the chairman of the powerful Finance Committee, said he disagreed with Mr. Alexander’s plan. “I think he’s trying to do a good thing, but it’s only temporary, and it leads us down a primrose path that we don’t want to go,” Mr. Hatch said.

Mr. Alexander, the chairman of the Senate Health Committee, said he received a telephone call on Wednesday from the president. “He wanted to be encouraging about the bipartisan agreement that Senator Murray and I announced yesterday,” Mr. Alexander said at a forum convened by Axios, a news website.

Mr. Trump “intends to review it carefully to see if he wants to add anything to it,” Mr. Alexander said of the Senate plan.

In fact, Mr. Alexander and Ms. Murray had already moved to address concerns that restoring the payments to insurers could be viewed as providing them with a “bailout.” On Tuesday, Mr. Alexander said that their deal would contain “the strongest possible language” to ensure that the money provided for the subsidies would go to benefit consumers, not insurers.

The bill drafted by Mr. Alexander and Ms. Murray would provide “such sums as may be necessary” through 2019 for cost-sharing payments to insurers under the Affordable Care Act. State insurance regulators would have to certify that insurers use the money to provide “a direct financial benefit to consumers.”

Mr. Alexander said later Wednesday that he was open to “improvements or changes that the president wants to make” in the deal and that he completely agreed with Mr. Trump that “we don’t want to bail out insurance companies.”


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The draft bill would also make it easier for states to obtain waivers from some requirements of the Affordable Care Act. But the bill includes protections for consumers: Any state plan would have to provide coverage “of comparable affordability, including for low-income individuals, individuals with serious health needs and other vulnerable populations.”

Not content to wait for Congress, the attorneys general of California, New York and 16 other states asked a federal district judge on Wednesday for a temporary restraining order that would force the Trump administration to continue making the subsidy payments. A court order is urgently needed, they said, because the next installment of federal subsidies is due on Friday.

The states, which filed suit against the federal government last Friday, said that the payments are required by the Affordable Care Act and that ending them would destabilize insurance markets and cause increases in premiums and in the number of uninsured.

A group of 10 governors — including four Republicans — also weighed in, writing in a letter to congressional leaders that the Alexander-Murray plan “deserves a vote by the House and Senate.”

On Wednesday, Mr. Alexander predicted that the plan would “pass in some form before the end of the year,” and he said that Mr. Trump had “engineered the bipartisan agreement by calling me and asking me to work with Senator Murray to do it.” Mr. Alexander said the deal included several victories for conservatives, making it easier for states to revamp their insurance markets and allowing people of any age to buy low-cost, high-deductible health plans providing catastrophic coverage.

A federal judge ruled in 2016 that the federal payments to insurance companies, known as cost-sharing reductions, violated the Constitution because Congress never provided money for them. The White House, describing the payments as unlawful, announced last week that they would be cut off.

Mr. Trump says he still supports longer-range efforts to repeal the Affordable Care Act and replace it with block grants to the states.

Such big changes would not take effect until 2020 or 2021, Mr. Alexander said, offering a warning against creating “chaos” in the meantime.

“What does chaos do?” Mr. Alexander asked. “It’s a four-lane highway to a single-payer solution. It’s a birthday present for Bernie Sanders,” the independent Vermont senator and leading advocate for a single-payer “Medicare for all” health care system.

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