The Trump administration on Thursday announced a new plan it says is aimed at lowering health care costs in the United States, but the proposal offers few details and largely repackages ideas President Donald Trump has floated for months, coming as Affordable Care Act open enrollment ends in most states.
The plan, branded “The Great Healthcare Plan,” was rolled out as Republicans in Congress struggle to reach an agreement to extend enhanced ACA tax credits that expired Dec. 31, driving higher premiums for millions of Americans. With the Senate preparing to leave for a weeklong recess, the timing further dims prospects for near-term legislative action.
Administration officials framed the proposal as a broad effort to rein in health care costs by lowering prescription drug prices, redirecting government subsidies from insurers to consumers and expanding price transparency requirements.
Trump has repeatedly promised a sweeping health care overhaul, and the outline arrives amid growing public concern over affordability. On Monday, federal data showed ACA sign-ups are running more than 800,000 below the same point last year, a decline experts say reflects higher premiums after the enhanced subsidies expired.
A central plank of Trump’s proposal is sending federal health care funds directly to patients rather than insurers, allowing individuals to purchase coverage on their own.
“The government is going to pay the money directly to you,” Trump said in a White House video. “It goes to you, and then you take the money and buy your own health care.”
Such an approach would require congressional approval, raising questions about whether and how it could be implemented. During a call with reporters Thursday, administration officials declined to say how direct payments would work, how much individuals would receive or who would qualify.
The administration said it is leaving Congress “broad” discretion to shape the details.
“We want to start to see that money moved directly to people,” an administration official said. “There are a lot of different ways that could take place. We are open to working with Congress on how to effectuate that.”
Trump has suggested the funds could be routed into health savings accounts to help cover deductibles and copays, an idea echoed by Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services.
Administration officials said the proposal does not preclude ongoing negotiations on Capitol Hill to extend the enhanced ACA subsidies. Earlier this month, the House passed a bill to renew the credits for three years, and the Senate is drafting its own version.
Trump, however, has indicated he may veto such an extension, arguing that his preferred approach is to give money directly to patients rather than subsidizing insurance premiums.
Officials urged Congress to act “without delay,” saying the administration’s plan would bring relief from what Trump frequently calls the “Unaffordable Care Act.”
Health policy experts across the ideological spectrum questioned the plan’s viability.
“When it comes to health reform, the devil is in the details, and this is very light on details,” said Cynthia Cox, director of the ACA program at KFF, a nonpartisan health policy research group.
Cox warned that shifting subsidies away from insurers could destabilize ACA marketplaces.
“It has the potential to severely impact the stability of the ACA marketplaces,” she said, adding that it could leave people with pre-existing conditions without affordable comprehensive coverage.
Art Caplan, head of the medical ethics division at NYU Grossman School of Medicine, criticized the idea of making patients “savvy shoppers” in a complex health care system.
“It’s a broken plan and a broken idea,” Caplan said, arguing consumers often lack the time or information to comparison shop during medical emergencies.
During Thursday’s call, Oz also highlighted Trump’s “most favored nation” drug pricing initiative, which ties U.S. prices to those paid in other wealthy countries. Trump first announced the effort last May, and the administration says it has reached agreements with 14 major drugmakers.
Oz also promoted TrumpRx, a new self-pay prescription drug platform set to launch later this month. Some experts have questioned how much savings the platform will deliver, noting that many insured patients already receive discounted prices and that some drugs included have cheaper generic alternatives.
The rollout underscores a broader political challenge for the administration: reconciling promises of lower health care costs with legislative gridlock and skepticism from experts, as voters increasingly cite affordability as a top concern.
With ACA open enrollment ending and Congress divided over extending subsidies, the fate of Trump’s health care proposals remains uncertain. Any shift to direct payments would require new legislation, and analysts say the lack of detail could complicate efforts to build support on Capitol Hill in the weeks ahead.
