By SUZANNE DOWNING
President Donald Trump on Thursday rolled out what he is calling “The Great Healthcare Plan,” a major proposal to overhaul how Americans receive federal assistance for health insurance. It would shift billions of dollars in taxpayer subsidies away from insurance companies and instead sending the money directly to consumers.
The plan, announced in a video message and detailed in White House fact sheets on Jan. 15, is Trump’s answer to the expiration of the Affordable Care Act’s enhanced premium subsidies on Dec. 31,2025, a policy change that led to higher monthly insurance costs for millions of Americans who were receiving special rates for insurance, while adding billions to the national debt.
Under the Trump proposal, instead of Washington routing subsidy payments through insurance companies, the federal government would provide eligible Americans with direct financial assistance, typically deposited into health savings accounts or similar consumer-controlled accounts, which individuals could then use to purchase the health coverage they choose.
“The government is going to pay the money directly to you. It goes to you, and then you take the money and buy your own healthcare,” Trump said in his announcement video. “The big insurance companies lose and the people of our country win.”
Trump sharply criticized the Affordable Care Act’s structure, which provides subsidies to insurers on behalf of consumers who buy coverage through government exchanges, arguing that the system rewards insurance companies while leaving families with rising premiums and fewer choices.
“Obamacare was designed to make insurance companies rich,” Trump said. “Billions of dollars in taxpayer subsidies helped their stock prices skyrocket while you paid more money for healthcare every single year.”
The Great Healthcare Plan would end those payments and instead place the subsidy money under the control of individuals, allowing consumers to shop for coverage in the private market rather than being limited to government-approved plans. White House officials say the goal is to increase competition, lower premiums, and give patients more leverage over insurers.
A major component of the proposal focuses on lowering prescription drug prices through what Trump calls a “most-favored-nations” pricing model, which would tie U.S. drug prices to the lowest prices paid by other developed countries. The administration has also launched a new direct-to-consumer platform called TrumpRx, which Trump says will allow Americans to purchase medications at sharply reduced prices.
“So instead of Americans paying the highest drug prices in the world, which we have for decades, we will now be paying the lowest cost paid by any other nation,” Trump said. “Your prescription drugs will come way, way down.”
The White House says some drug prices could fall by 80% or more under the program, though independent analysts have not yet reviewed the full pricing structure.
The plan would also impose new transparency and reporting requirements on insurance companies and hospitals, requiring them to publish prices, coverage comparisons, how much revenue is paid out in claims versus profits, and data on claim denials and appeals. Hospitals and insurers that accept Medicare or Medicaid would be required to publicly post their prices so patients can compare costs before seeking care.
“Sunlight is the best disinfectant,” Trump said. “We will have maximum price transparency, and costs will come down incredibly.”
While Trump is ending insurer-based subsidies, the proposal would continue funding the Affordable Care Act’s cost-sharing reduction program, which lowers deductibles and out-of-pocket costs for lower-income enrollees. The White House estimates that this alone could reduce premiums on some exchange plans by 10 to 15 percent.
The Great Healthcare Plan is not yet law. Trump is urging Congress to move quickly to turn the framework into legislation, but key details, including how much assistance individuals would receive and how the new system would interact with existing insurance rules, have not yet been released.
Democrats have already criticized similar proposals in the past, arguing that direct-payment models do not adequately protect people with serious medical conditions or stabilize insurance markets, while Republicans say the plan represents a long-promised shift away from Obamacare toward a patient-centered system that restores consumer choice.
