Photo from The White House
“The Great Healthcare Plan stops sending big insurance companies billions in extra taxpayer-funded subsidy payments and instead send that money directly to eligible Americans to allow them to buy the health insurance of their choice.” — from The White House fact sheet, Jan. 15, 2026
WASHINGTON D.C. — President Donald Trump on January 15 unveiled a new health policy framework branded “The Great Healthcare Plan,” a set of proposals the White House says is aimed at lowering health care costs and expanding consumer choice. The initiative is framed by the administration as a reworking of Affordable Care Act–era subsidy design, not a formal repeal of the law.
Outlined in White House fact sheets and briefing materials, the plan is presented as a policy framework rather than enacted legislation. Administration officials said most of its provisions would require congressional approval and subsequent regulatory action.
A reorientation after subsidy changes
The rollout comes after enhanced Affordable Care Act premium subsidies expired on December 31, 2025, a change that led to higher out-of-pocket costs for some enrollees beginning in 2026. The Affordable Care Act itself did not expire and remains federal law, including its insurance marketplaces and consumer protections, unless Congress acts to repeal or amend it.
Against that backdrop, the Trump administration has positioned its proposal as a response to how federal health assistance has been structured under the ACA framework.
Shifting subsidies from insurers to individuals
Under the proposal, the administration would move away from certain ACA subsidy mechanisms by sending federal assistance directly to eligible Americans, allowing them to purchase health coverage of their choosing, a shift the administration argues would move assistance away from insurer-administered subsidy structures established under the ACA.
The White House argues that the change would reduce taxpayer costs and lower insurance premiums, citing internal projections and referencing Congressional Budget Office analyses. Detailed legislative language and formal budget scoring have not yet been released, and the ultimate fiscal impact would depend on how Congress structures any implementing legislation.
Administration officials emphasized that the proposal does not repeal the Affordable Care Act, which remains in force unless Congress acts. Instead, they described the plan as an effort to reorient federal health policy toward a more consumer-directed model by reworking ACA-era subsidy delivery, while leaving the broader law intact.
Drug pricing and expanded access
On prescription drugs, the plan calls on Congress to codify “most-favored-nation” pricing, an approach the administration says would bring U.S. drug prices closer to those paid in other developed countries. The White House said previously negotiated voluntary pricing arrangements with federal health agencies would be preserved.
The proposal also seeks to expand the number of medications approved for over-the-counter sale. Administration officials argued that broader access could reduce out-of-pocket costs and limit the need for certain physician visits, particularly for routine conditions.
New disclosure requirements for insurers and intermediaries
The framework proposes a significant expansion of transparency rules for insurers and health care intermediaries. Insurers would be required to present coverage information in what the White House describes as plain language, enabling consumers to compare plans more easily.
The plan also calls for public disclosure of claim denial rates, average wait times for routine care, and how premium revenue is allocated among medical claims, administrative costs, and profits. These measures would build on existing federal transparency requirements but expand their scope and enforcement.
Pharmacy benefit managers are also targeted under the proposal. The White House says it would seek to end rebate and fee arrangements that it argues contribute to higher drug costs, though any changes would require legislative or regulatory action.
Pricing disclosures tied to federal programs
Another provision would condition participation in Medicare and Medicaid on compliance with expanded pricing disclosure requirements. Providers and insurers accepting federal funds would be required to prominently post prices and fees, an effort the administration says would strengthen enforcement of existing transparency laws and reduce unexpected medical billing.
Administration officials said prior transparency initiatives were unevenly enforced and argued that stronger oversight would be necessary if the proposal is enacted.
A framework facing congressional debate
The White House stressed that “The Great Healthcare Plan” is a policy blueprint rather than a finished bill. Major elements, including the proposed reworking of ACA-era subsidy design, drug pricing changes, and expanded disclosure mandates, would require congressional approval.
National reporting has noted that the proposal is expected to face debate over its potential effects on lower-income Americans and insurance market stability, particularly the shift toward consumer-directed payments. Administration officials said additional legislative details would be released as the plan moves through the congressional process.
For now, the rollout signals a renewed effort by the Trump administration to reshape federal health policy by revisiting how affordability assistance is delivered, while leaving the Affordable Care Act itself intact unless Congress chooses otherwise.
