House passage of an Obamacare repeal bill sets up a process that could take weeks or even months before the Senate arrives at its own bill, but in the meantime, the Trump administration will face a more immediate question.
Should it continue propping up struggling insurance companies under Obamacare, or not?
Trump recently told the Washington Examiner that his decision on whether to help insurers pay for subsidies given to low-income Obamacare customers would depend on what happens to the GOP's American Health Care Act.
"So I really have to see what happens over the next couple of days or maybe weeks with respect to our plan before I make that decision," he said when asked about these "cost-sharing reduction payments."
But on Thursday, the House's passage offered no clues as to what the Trump administration might choose to do with the payments. Trump has threatened to pull them before, but then said they would continue.
The White House didn't return a request for comment on what the House victory means for paying out cost-sharing reduction payments over the long term.
Insurers have been pleading with the Trump administration for an answer on whether the payments will be there for 2018, as rate filing deadlines are around the corner. Last month, California even told insurers they could file their regular expectations for premiums under Obamacare, and "Trump rates" that would reflect higher prices of the cost-sharing payments were to end.
America's Health Insurance Plans, the insurance industry's main lobbying group, even mentioned the payments in its statement on the AHCA's passage."We need certainty now about funding for cost-sharing reductions," the group said.
The group told the Washington Examiner it has not received any additional clarity from the White House on the cost-sharing payments since passage of the bill Thursday afternoon.
While Trump could opt to wait until the Senate decides on how to handle the bill, a decision may be needed faster than that, especially if the Senate needs several weeks to pass its own bill, or if it finds it can't pass any bill.
The House-passed AHCA would keep Obamacare's cost-sharing payments in place for a few years, which could mean Trump is willing to pay them out as the bill gets passed.
But there is no guarantee that language survives in the Senate, or that the Senate can pass any bill. Several senators said Thursday they are looking to write their own bill and incorporate elements of the House bill into it, and there is no deadline for them to get a bill together.
In the meantime, withholding the payments could have a dramatic effect on the insurance market, as insurers would still have to lower copays and deductibles for low-income Obamacare customers under the current law. Some insurers have said they would leave the market or dramatically raise prices as early as this year without the payments.
Last year, the Obama administration paid out $7 billion in cost-sharing payments to insurers. But that was under the Obama administration, which fought the House in a lawsuit over the legality of the payments.
A federal judge ruled last year that the payments illegally bypassed Congress and should first be appropriated, but delayed the ruling until an appeal from the Obama administration was exhausted. It remains unclear if Trump intends to continue the appeal, and a status report on the lawsuit is due on May 22.
Several top administration officials have hinted that they may drop the appeal, such as Attorney General Jeff Sessions, who has said he thinks the payments are unconstitutional.
Insurance companies can only sit and wait for a decision from the Trump administration, but the clock is ticking. Some states have already called for preliminary rates for 2018, such as Maryland, which unveiled some insurers seeking price hikes of up to 50 percent. Insurers have a federal deadline to submit rates in June.