Republicans have grappled with reforming Obamacare before, during the first Trump administration, but their efforts to pass legislation repealing the ACA famously failed after late Arizona Republican Sen. John McCain voted in 2017 against one of its attempts by giving it the thumbs down, calling it a “shell of a bill.”

Democrats went on to net 40 seats in the House during the 2018 midterm elections, after hammering the GOP on Obamacare and the party’s failed efforts to repeal and replace it.

Now, one year before the 2026 midterm elections, Republicans could find themselves in a similar position, in which Trump and Republicans lose unilateral control of Congress, as healthcare is repeatedly the third most important issue to polling respondents, with 11% telling Economist and YouGov pollsters during the past week that it is their No. 1 concern.

In that poll, healthcare was only outpolled by inflation and prices at 25% and jobs and the economy at 16% as respondents’ top issue, as people this month were advised that their insurance premiums are going up.

Not only that, but Democrats also hold an average 5 percentage point advantage over Republicans on generic congressional ballot polling, at least according to RealClearPolitics.

The White House, under pressure to address the issue of affordability that was raised by this month’s off-year elections in New Jersey and Virginia, has defended its policies regarding the cost of healthcare amid Republican resistance this week, the latest example of Trump’s weakening grip on the party.

The Trump administration “has been focused on robustly tackling our expensive and inefficient healthcare system for months, by signing historic deals with pharmaceutical companies to drug prices, accelerating approval for cheaper generic drugs, and slashing the waste, fraud, and abuse in Medicaid,” White House spokesman Kush Desai told the Washington Examiner when asked whether there are concerns Republican inaction will open the GOP up to political attacks from Democratsin light of the recent government shutdown.

“As these and other critical reforms continue to take effect, Americans can count on better and more affordable healthcare,” Desai said.

Regardless, reports that Trump was planning to announce his proposals as early as last Monday, although no event was scheduled because of the pushback, is an acknowledgement of the political problem the White House and congressional Republicans are contending with.

Republican strategist Lanhee Chen, who was also 2012 GOP presidential nominee Mitt Romney’s campaign chief policy adviser, implored the party to “go on offense,” presenting “their own healthcare proposals to lower costs and improve access.”

“A failure to do so represents a lost opportunity with potential electoral consequences,”  Chen told the Washington Examiner. “The Democrats’ solution, a simple extension of enhanced Obamacare subsidies, does nothing to solve the real challenges our healthcare system faces. Yet they can gain the upper hand here if Republicans fail to do something to move the conversation forward.”

The last Economist-YouGov tracking poll, conducted before the government reopened on Nov. 12, reported that a plurality of respondents supported the shutdown over the tax credits at 41%. Another 39% did not, while 20% told pollsters they were unsure, as Republicans remained adamant they were prepared to discuss healthcare policy with the government open.

That polling underscores the “tough spot” in which congressional Republicans find themselves, though more would not mind permitting the tax credits to expire, according to Claremont McKenna College politics professor John Pitney.

“On the one hand, anything bearing [former President Barack] Obama’s name is toxic to GOP activists,” the former Republican strategist told the Washington Examiner. “On the other hand, the general public now favors the Affordable Care Act by nearly a two-to-one margin. And about half of those who receive ACA premium subsidies are either self-employed or work for a small business, exactly the kind of voters that marginal Republicans need in a general election. It’s hard to see how they get through this issue without political damage.”

To that end, Republican strategist Ryan Berger, a principal of GOP lobbying shop Navigators Global, argued the party should reiterate how “Democrats created Obamacare and its ever higher premiums entirely of their own making.” 

“Even so, President Trump realizes the impact premium hikes will have on many folks and appears to be smartly working to craft sensible limitations to help restore the support,” Berger told the Washington Examiner. “Congressional Republicans should take a win when they see one, even if most of them would go further. Affordability is a real concern for people across the country and as the calendar turns over to 2026 and an election year, the White House focusing on that topic is important to protect the congressional majority.”

However, Trump’s proposal, which was set to include a two-year extension of the Obamacare tax credits, in addition to new eligibility requirements, from an income cap at 700% of the federal poverty line to minimum premium payments, according to reports, rankled congressional Republicans, despite the proposal sharing similarities with a stopgap plan the likes of Sen. Katie Britt (R-AL) privately pitched to the president last week, in part, because of White House’s lack of outreach.

House Speaker Mike Johnson (R-LA) even told the White House and senior administration officials during a phone call on Monday night that House Republicans are not interested in extending the Obamacare tax credits, as members of his conference have publicly but anonymously expressed their frustrations with the administration’s congressional liaison team thus far.

On the other side of the U.S. Capitol, Senate Majority Leader John Thune has promised to hold a vote on the Obamacare tax credits by Dec. 12. Nevertheless, it is unclear whether that will be a clean extension bill or a compromise measure, such as the one proposed by Trump, with Republicans pushing for protections for the Hyde Amendment, which prevents federal funding being spent for abortions – a poison pill for Democrats.

Meanwhile, Rep. Tim Burchett (R-TN) praised Trump for starting negotiations with his proposal, a process welcomed by Democrats.

“We’ve got to quit pointing fingers; we’ve got to start doing something with this thing. At least Trump’s proposal does something,” Burchett said in a video posted on social media. “It keeps people from losing their insurance, and it verifies that it’s not a bunch of frauds.”

The White House had declined to comment on the proposal, reportedly called the “Healthcare Price Cuts Act,” with press secretary Karoline Leavitt only telling reporters on Monday that “healthcare is a topic of discussion that’s happening very frequently and robustly inside the West Wing right now.”

TRUMP FREEZES 2028 FIELD AS SOME BELIEVE NON-ALIGNED CANDIDATE MAY BE GOP’S BEST BET

“The president is very much involved in these talks, and he’s very focused on unveiling a healthcare proposal that will fix the system and will bring down costs for consumers,” Leavitt said. “As for the details of those discussions, I’ll let the president speak for himself.”