Axios

Republicans are taking a harder line against extending enhanced Affordable Care Act subsidies — and doubling down on an alternative plan that would send the money directly to consumers.

Why it matters: President Trump's opposition to an extension makes it increasingly unlikely that Republicans will agree to renew the tax credits, even though it's not clear how the GOP alternative would work or whether the party can reach a consensus.

President Trump on Tuesday told Congress not to "waste" its time on an extension of enhanced Affordable Care Act subsidies, saying they would only enrich insurance companies.

Why it matters: Trump's Truth Social post takes a harder line against the subsidies at a time when some in Congress are still hoping for a bipartisan deal to extend them and head off a sharp increase in premium costs for millions of Americans.

What they're saying: Trump doubled down on his idea to send ACA subsidy money directly to consumers.

• "THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE," Trump wrote.
• He said people could "buy their own, much better, insurance" and Congress should not "waste your time and energy on anything else."

Between the lines: It's not clear how Trump's plan would work.

• Some in Congress have floated using health savings accounts to help consumers pay out of pocket expenses.
• But Trump referenced giving people money to buy health insurance, which is how the ACA marketplaces work.
• One option could be allowing consumers to buy health plans with cheaper, skimpier coverage that don't comply with the ACA. Experts warn that such a move could destabilize the ACA markets.

The bottom line: Trump's post throws a wrench into efforts in Congress to extend the subsidies, which expire at the end of the year if lawmakers don't act.

Almost half U.S. adults are worried they won't be able to afford needed health care in the coming year, according to a West Health-Gallup survey — the highest level recorded since the organizations began tracking the measure in 2021.

Why it matters: Challenges to the public's health and financial wellbeing are expected to loom large heading into the midterm election cycle.

• Affordability concerns already are driving the congressional debate over whether to renew enhanced Affordable Care Act enhanced tax credits and President Trump's drug price deals.

What they found: Only about half of U.S. adults (51%) believe basic health care is affordable and accessible — a 10 percentage point drop since 2022.

• Affordability among Black and Hispanic Americans has dropped by 13 and 17 points to 41% and 34%, respectively, while it's remained steady for white Americans at 58%.
• 1 in 5 Americans say that they or someone in their household couldn't pay for prescription medications in the past three months.

West Health and Gallup tallied self-reported health care experiences in the every state and the District of Columbia, finding Iowa ranked first for cost, quality and access while Alaska ranked last.

• The survey of 19,535 adults was conducted from June 9 to August 25.

The Trump administration's termination of federal research grants earlier this year disrupted about 1 in 30 clinical trials funded by the National Institutes of Health, new research shows.

Why it matters: More than 74,000 patients were enrolled in the interrupted trials.

Some closely watched federal health websites and datasets that went dark during the government shutdown haven't been updated since the reopening.

Why it matters: The pause in critical information leaves the public and providers in the dark about threats with the holidays approaching.