Trump Announces “The Great Healthcare Plan,” Proposing Direct Payments, Price Transparency, Insurance Reform

President Donald J. Trump announced “The Great Healthcare Plan,” calling on Congress to enact the plan aimed at lowering prescription drug costs, reducing insurance premiums, and redirecting taxpayer-funded subsidy payments directly to patients rather than insurers and pharmaceutical manufacturers.¹ The proposal represents the administration’s latest attempt to reshape the US health care landscape amid ongoing debates over affordability and uncertainty about the future of the Affordable Care Act (ACA).

A fact sheet about the plan released by the White House lists 4 main components: lowering drug prices, lowering insurance premiums, holding stakeholders accountable, and maximizing price transparency. The broad plan outline comes as premiums for coverage on ACA marketplaces significantly increase and ACA subsidies are still in discussion after the House of Representatives voted to extend them.^2,3

Trump has consistently pushed for Most Favored Nation (MFN) drug pricing and struck voluntary deals with 16 of 17 target pharmaceutical companies to push this initiative forward,⁴ as experts warn that plans to implement the strategy lack details.⁵ The Great Healthcare Plan aims to codify MFN deals and grandfather in the existing deals.¹ It also makes more drugs available for over-the-counter purchase, according to the announcement.

“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.… That’s what we’re going to pay, and the American people will get the savings,” Trump said in a video of the announcement.⁶ Critics of MFN drug pricing argue that research and development programs could suffer if MFN drug pricing is enacted in the US and that solutions to drug pricing must be tailored to the US to ensure Americans maintain access to cutting-edge therapies across disease states.⁷

Trump’s proposal also includes replacing existing government insurance subsidies with direct payments to eligible individuals to purchase their health insurance, referring to the subsidies as a “flagrant scam.”¹ The Great Healthcare Plan proposes sending money directly to health savings accounts (HSAs). This comes shortly after the House of Representatives voted to extend ACA subsidies and as bipartisan talks are in progress to hopefully negotiate a compromise that will result in a bill.³ 

The fact sheet claims that the plan will fund a cost-sharing reduction program for health care, save taxpayers at least $36 billion, reduce the most common ACA plan premiums by over 10%, and “end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen that deceptively raise the cost of health insurance.”¹ No additional details were noted, including the specific kickbacks the announcement is referring to.

The plan also aims to increase accountability and price transparency with a “‘Plain English’ insurance standard,” according to the announcement.

“It requires insurers to publish detailed information about how much of your money they’re going to be paying out in claims vs how much they are taking in in profits.… It forces them to release detailed data on how many claims are being denied and whether those denials are eventually overturned on appeal,” Trump said.⁶

Price transparency extends to health care providers or insurers who accept Medicare or Medicaid, demanding that they post pricing and fees prominently in their place of business and ensure insurance company compliance with price transparency requirements.¹ In Trump’s first term, his administration finalized a rule that included requirements for insurance plans to post in-network prescription drug pricing and hospitals to disclose what they charge for services.⁸ The proposed Great Healthcare Plan pushes to enforce these measures.¹  

“The Great Healthcare Plan…[is] great health care at a lower price [and] mandates unprecedented accountability and transparency from insurance companies and all health care providers so that special interests can no longer profiteer at your expense,” Trump said.⁶

References

1. Fact Sheet: President Donald J. Trump calls on Congress to enact The Great Healthcare Plan. The White House. January 15, 2026. Accessed January 15, 2026. https://www.whitehouse.gov/fact-sheets/2026/01/fact-sheet-president-donald-j-trump-calls-on-congress-to-enact-the-great-healthcare-plan/

2. Mattina C. Newly unveiled ACA premiums show 26% average increase before subsidy expiration. AJMC^®. October 29, 2025. Accessed January 15, 2026. https://www.ajmc.com/view/newly-unveiled-aca-premiums-show-26-average-increase-before-subsidy-expiration

3. Bonavitacola J. House votes to extend ACA subsidies, eyes turn to Senate. AJMC. January 8, 2026. Accessed January 15, 2026. https://www.ajmc.com/view/house-votes-to-extend-aca-subsidies-eyes-turn-to-senate

4. Grossi G. AbbVie joins Trump drug pricing effort, pledges $100B in US R&D investment. AJMC. January 13, 2026. Accessed January 15, 2026. https://www.ajmc.com/view/abbvie-joins-trump-drug-pricing-effort-pledges-100b-in-us-r-d-investment

5. Grossi G. Most Favored Nation drug pricing moves forward, but experts warn details are still missing. AJMC. November 5, 2025. Accessed January 15, 2026. https://www.ajmc.com/view/most-favored-nation-drug-pricing-moves-forward-but-experts-warn-details-are-still-missing

6. The Great Healthcare Plan. The White House. Accessed January 15, 2026. https://www.whitehouse.gov/greathealthcare/

7. McNulty R. A "one-two punch" to innovation? The Most Favored Nation order and broader US drug pricing reform. AJMC. October 10, 2025. Accessed January 15, 2025. https://www.ajmc.com/view/a-one-two-punch-to-innovation-the-most-favored-nation-order-and-broader-us-drug-pricing-reform

8. Inserro A, Joszt L. HHS wraps up rule requiring price transparency by payers. AJMC. October 29, 2020. Accessed January 15, 2026. https://www.ajmc.com/view/hhs-wraps-up-rule-requiring-price-transparency-by-payers