Trump’s ‘Great Healthcare Plan,’ explained

This week, U.S. President Donald Trump presented “The Great Healthcare Plan,” a framework of proposals that the White House says will reduce healthcare costs, lower drug prices, and alleviate the impact of rising health insurance premiums. The announcement comes at a time when millions of Americans are facing substantial increases in their Affordable Care Act (ACA) premiums, and less than a year before the midterm elections, in which healthcare is likely to be a central issue.

What exactly is the Great Healthcare Plan?

More than a bill, the Great Healthcare Plan is a one-page document that sets out a series of broad goals. The administration describes it as a framework to be developed by Congress into concrete legislation.

According to the White House, the plan is based on four main pillars:

• Reducing the price of medicines
• Lowering health insurance premiums
• Holding large insurers accountable
• Maximizing price transparency in the healthcare system

Despite the ambitious goals, no legislative text, implementation schedule, or detailed estimates of how the measures would be implemented were presented.

How does it propose to reduce drug prices?

One of the central pillars of the plan is the codification of Trump’s “most-favored nation” agreements, which seek to have the United States pay the same price for certain drugs as other developed countries.

The proposal is based on voluntary agreements negotiated with pharmaceutical companies and overseen by the Department of Health and Human Services (HHS), led by Robert F. Kennedy Jr., and the Centers for Medicare and Medicaid Services (CMS).

In addition, the plan proposes expanding the list of drugs available without a prescription, provided they are considered safe. According to the White House, this would reduce costs, increase competition, and decrease the need for doctor visits to obtain prescriptions.

Trump has also promoted parallel initiatives to offer lower-priced drugs to consumers on the TrumpRx website. However, these are not directly part of the legislative framework presented and their impact has been very limited.

What changes does he propose for health insurance?

The most controversial point of the plan is the proposal to redirect federal funds directly to citizens, rather than sending them to insurers.

Currently, the government subsidizes insurance companies to reduce the cost of ACA premiums. Trump proposes eliminating those additional payments and depositing the money into health savings accounts (HSAs) for eligible Americans, so they can purchase the insurance of their choice. The president has repeatedly criticized ACA subsidies, calling them a benefit to insurers, and argues that the money would be better off in the hands of consumers.

However, HSAs have significant limitations that have raised concerns among health policy experts: they are only available for certain types of high-deductible plans and cannot be used to pay monthly premiums.

Will ACA supports be reinstated?

The plan also calls for restoring the cost-sharing reduction program, an ACA mechanism that helps cover expenses for low-income individuals. This program was suspended in 2017 during Trump’s first term following a court battle.

According to the White House, reactivating this mechanism would save taxpayers at least $36 billion and reduce premiums for the most common ACA plans by more than 10%. However, experts point out that the way this measure is combined with the elimination of current subsidies could reduce the total assistance for some beneficiaries.

What does “holding insurers accountable” mean?

The Great Healthcare Plan introduces the concept of “Plain English Insurance.” Under this proposal, insurers would have to publish understandable comparisons of prices and coverage on their websites.

In addition, they would have to report:

• The percentage of revenue spent on paying medical claims versus administrative expenses and profits.
• Claim denial rates.
• Average wait times for routine medical care.

Although some of this information is already reported to regulators, the plan seeks to make it more visible and accessible to consumers.

Another key measure is to require providers and insurers that accept Medicare or Medicaid to prominently display their prices and rates. The goal is to avoid surprise bills and encourage competition.

Trump has championed this idea since his first term, arguing that knowing prices would allow patients to make better decisions and reduce overall costs. However, previous experiences with similar regulations have shown low compliance and limited impact on prices.

Who does the plan leave out?

One of the most criticized aspects of the Great Healthcare Plan is that it does not explicitly address coverage for people with pre-existing conditions. The White House itself confirmed that the framework presented would have no direct impact on this group, leaving the issue for future negotiations with Congress.

Nor does it include an immediate solution for the millions of people facing drastic increases in ACA premiums following the expiration of expanded subsidies this year. Although there are bipartisan negotiations in the Senate to extend these subsidies, Trump’s plan neither explicitly supports nor blocks them.

Does it have a real chance of moving forward in Congress?

Although Republicans control both chambers, several of the proposals would require complex legislative approval and could face resistance even within the party itself. Some Republican lawmakers, such as John Thune (South Dakota) and Bernie Moreno (Ohio), have shown general support for the ideas of cost reduction and transparency, but without committing to a specific text.

Meanwhile, health experts and organizations warn that without clear details, the plan could create uncertainty in insurance markets and leave millions of people unprotected.

Meanwhile, Trump’s bet on rural health

In parallel with the Great Healthcare Plan, the Trump administration has launched its Rural Health Transformation Program, a $50 billion federal fund aimed at strengthening the healthcare system in rural communities over the next five years.

The program, already authorized by Congress, guarantees at least $100 million annually to each state through 2030, with additional allocations based on the size of the rural population and the needs of its hospitals. The resources seek to improve access and quality of care through investments in prevention, chronic disease management, mental health, technological innovation, and retention of medical personnel in rural areas.

Although the White House presents these investments as historic and bipartisan, critics point out that this $50 billion contrasts with much larger cuts recently approved for programs such as Medicaid and the ACA itself. They also express concern about the lack of transparency in some allocation criteria and the incentive for states to align themselves with policies that the White House considers a priority.

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