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.
9 thoughts on “Trump unveils ‘Great Healthcare Plan’ to replace Obamacare subsidies with direct payments to patients”
Naturally the Democrats wont like anything President Trump comes up with as an alternative solution to their beloved “Obamacare” if it does not include free healthcare to illegal migrants. They will insist it is racist to exclude any human that walks into an ER for anything from drug overdose to abortion or an emergency gender transitional surgery.
Great move in the direction of single-payer insurance, Donald! Now keep moving in that direction until insurance companies no longer exist. See? The socialistic approach really is a good and workable solution.
Just look at the other 33 of 34 developed countries in the world that all have universal systems. It’s just better that way.
Huh?
Millions of Americans or American businesses shopping for the insurance product that works for them and their situation on the open market, how is that single payer? What’s wrong with insurance companies having to compete.
I hope we get more co-ops where families can pay a set fee per month and get care when they need it from their doctor. No co-pay, no paperwork, no pre-authorizations just care when you need it. This coupled with a catastrophic care only plan, would work great for the vast majority of folks.
I grew up under an “universal system” and it sucks! Long waits, unavailable specialty care, lots of out of pocket expense, because your prescription isn’t in the formulary, poor reimbursement for doctors and paperwork, loads and loads of paperwork.
Hans pie in the sky may sound good, but it never works. Consider Canada now officially pushing their citizen to off themselves for all kinds of reasons. It alleviates the pressure on their health system AND eliminates more expense down the road as citizens age. Is that what you want?
Funny, I lived under one in the UK for a long time and it worked just fine. All healthcare is rationed one way or another. The US rations by ability to pay, which is unjust. The UK rations it by waiting periods and by eliminating fancy stuff, but it works fine and is much more equitable and accessible.
Insurance companies taking profits from denying care is not only unethical, it is sinful and criminal. Apparently you’ve never known anyone who needed lifesaving care but was denied, and nowadays probably by an AI bot.
Apparently, you’ve never known anyone who needed life-preserving care, was placed on an eight-month waiting list, and passed away before they could see the specialist. It’s the ‘Die before we Try’ program now deployed in Canada. What you found in the UK is probably okay for healthy youth, but it doesn’t work for the geriatric crowd. Or, perhaps you would return to the system of which you claim to be so fond and send us regular reports.
WAFI!
Hans sadly your post is all over the place.
You argue that rationing is equitable. There can not be an “equitable rationing” as each patient’s needs and circumstances are unique to that patient requiring different resources. One size fits no one. Furthermore in many European nations or Canada those with means get special treatment by either seeking care elsewhere or preferential treatment in the system itself (as in “private wards and specialists). So your argument falls flat as it appears to be the same as the ACA in which Britain/insurance bureaucrats make cookie cutter choices based on the bottom line, while those who can afford it pay privately. Oh and news flash “the fancy stuff” isn’t a luxury. It is medical science moving forward and providing a better outcome by better diagnostics and treatments.
“Insurance companies taking profits from denying care is not only unethical, it is sinful and criminal”
I wholeheartedly agree with you on that, profiteering is disgusting especially if it causes misery and a shortened lifespan for patients. The issue with Obamacare is simply that these insurance companies get paid by the government and then have no incentive to provide more than the minimum, or make it difficult and expensive to actually use the so-called “coverage” with the patient having no recourse. The same can be said for the Canadian or British system, where bureaucrats assess your usefulness to society and then allow or deny care. The again patient has no recourse.
“Apparently you’ve never known anyone who needed lifesaving care but was denied,…..” I have and in both systems, so your claim that universal care is better is incorrect.
The solution is two-fold:
First put the patient in charge of what kind of coverage they want and are willing to pay for with an HSA. Have insurance companies compete on the open market for customers. Allow patients to switch carriers at any time, if they are not satisfied with the service they get and let them keep their insurance and coverage even if they move across the country. Allow co-ops and private pay, offer catastrophic plans. Convert Medicare to HSA( as a partition on the general HSA account) for anyone under 30 with their Medicare contribution going into that account accessible at the age of 65 and phasing out the old system. This would provide each individual the ability to direct their care as needed and keep their doctor and clinic. Patients negotiating directly with their doctor or joining their co-op would allow doctors to get fairly paid and eliminate a great deal of extraneous paperwork and administrative staff, cutting costs for all.
Medicaid being a TEMPORARY program should continue to be administered by the states.
Second institute tort reform. A great deal of healthcare cost is generated by procedures not essential due to the prospect of legal ramifications down the line. This drives up the cost for all, to say nothing of the cost associated with legal fees and insurance. Limit awards. Eliminate drug advertising. A great deal of resources are spent dealing with patient perceived need for expensive drug intervention, whether or not it is indicated as the proper treatment.
I am in favor of family doctors and hospitals like Mayo clinic or St. Jude’s where patients come first and the needs of the INDIVIDUAL patient are the driving force.
It should also be pointed out that you will get emergency care regardless of your ability to pay.
Oh and I need to correct myself, I have seen people denied for live prolonging(experimental chemo) or comfort care (joint replacement etc), never for emergency care.
Lifesaving care is care during an emergency with a high probability of death in the very short term (like 0-24 hours) everything else is life-prolonging/comfort care.
Rationing is a denial of service.
It took the disaster president 10 years to come up with a one page “Great” healthcare plan. You’d be a fool to put any trust in this wimpy plan.
The real problem is a healthcare industry that is profit driven. Hospitals make a profit. Insurance companies make profits. Medical supply makes a profit. Pharmaceutical companies make profits. The healthcare side of toxic capitalism. If hospitals and pharmaceutical companies and clinics and medical living centers were only allowed to charge what was necessary to pay the bills (doctors, nurses, staff, buy required equipment, pay utilities, etc) and not make profits for investors, that portion of healthcare would be less expensive. If pharmaceutical companies were limited to reasonable profit margins like other manufacturers (and like in Europe and other nations), drugs would be less costly.
The current healthcare insurance system based on profits restricts and/or denies various treatments based on costs rather than medical expertise and recommendations for patients. Treatment is based on shareholder profits rather than patient needs. The less an insurer has to pay means more for shareholders.
Healthcare should not be a business, it should be a service available to everyone. Yes, folks need to pay for their care, but not to make investors rich.