Congress has reconvened in what has been colorfully dubbed the "December of Hellth," facing a ticking clock to resolve the fate of expiring Obamacare tax credits, a decision that could affect health insurance costs for millions of Americans. The consensus on Capitol Hill is that the outcome heavily depends on President Donald Trump’s unpredictable stance.

In the aftermath of a legislative break, interpreting Trump’s intentions has become increasingly challenging. Initially, Trump seemed on the verge of endorsing a framework to extend the Affordable Care Act (ACA) subsidies with new eligibility restrictions. However, he retreated following backlash from within his own party. He later expressed reluctance to extend the subsidies but acknowledged the potential necessity of doing so.

Lawmakers are now scrambling to decode Trump’s mixed signals and align their strategies accordingly. "The president has got to sign whatever we do, otherwise it’s a legislative exercise," stated Rep. Brian Fitzpatrick, a Pennsylvania Republican. Fitzpatrick is drafting a bipartisan proposal that attempts to echo the sentiments of a leaked White House framework from last week.

The Senate is poised to vote on December 9 on a yet undefined health care proposal, which was promised as part of a bipartisan deal to reopen the government. Meanwhile, Fitzpatrick and other moderates are striving to build bipartisan support for extending the subsidies with added income restrictions and other safeguards. These efforts have received some support from the Republican Main Street Caucus.

Behind the scenes, a coalition of House and Senate Republicans, including key committee chairs, are exploring a range of potential proposals. Yet, there’s no certainty that the GOP will unify around a proposal or that a bill will materialize this year. Senate Finance Chair Mike Crapo (R-Idaho) emphasized his commitment to finding a bipartisan solution, distinct from a budget reconciliation bill.

As a contingency, centrist House Republicans are prepared to initiate a discharge petition to force a floor vote on extending the subsidies, while giving the Senate space to broker a bipartisan agreement. However, Democrats have not yet unified around a strategy, with some pushing for a more comprehensive health care plan advocated by independent Sen. Bernie Sanders, which is unlikely to attract GOP support.

The complexity of negotiations reflects a broader struggle on Capitol Hill, where any agreement seems provisional until President Trump’s approval is secured. "That’s the trouble today," remarked Sen. Chris Murphy (D-Conn.). "You can have good-faith negotiations with Republicans, but it just doesn’t matter until Donald Trump weighs in."

As Congress faces these intricate health care negotiations, they are also navigating appropriations challenges, including advancing major funding bills and potentially tying them to a year-end agreement on health insurance subsidies. Additionally, the final text of a compromise version of the National Defense Authorization Act is expected soon, setting the stage for another potential legislative showdown.

As the December deadline looms, all eyes remain fixed on President Trump, whose decision will largely determine the trajectory of health care policy in the United States.