President Donald Trump on Thursday announced the outlines of a health care plan he wants Congress to take up as Republicans have faced increasing pressure to address rising health costs after lawmakers let subsidies expire.
The cornerstone is his proposal to send money directly to Americans for health savings accounts so they can handle insurance and health costs as they see fit. Democrats have rejected the idea as a paltry substitute for the tax credits that had helped lower monthly premiums for many people.
“The government is going to pay the money directly to you,” Trump said in a taped video the White House released to announce the plan. “It goes to you and then you take the money and buy your own health care.”
Trump’s plan also focuses on lowering drug prices and requiring insurers to be more upfront with the public about costs, revenues, rejected claims and wait times for care.
Trump has long been dogged by his lack of a comprehensive health care plan as he and Republicans have sought to unwind former President Barack Obama’s signature legislation, the Affordable Care Act. Trump was thwarted during his first term in trying to repeal and replace the law.
When he ran for president in 2024, Trump said he had only “concepts of a plan” to address health care. His new proposal, short on many specifics, appeared to be the concepts of a plan.
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, described it to reporters on a telephone briefing as a “framework that we believe will help Congress create legislation.”
It was not immediately clear if any lawmakers in Congress were working to introduce the Republican president’s plan. A White House official who was not authorized to speak publicly and described some details on condition of anonymity said the administration had been discussing the proposal with allies in Congress, but was unable to name any lawmakers who were working to address the plan.
Few specifics on health savings accounts
The White House did not offer any details about how much money it envisioned being sent to consumers to shop for insurance, or whether the money would be available to all “Obamacare” enrollees or just those with lower-tier bronze and catastrophic plans.
The idea mirrors one floated among Republican senators last year. Democrats largely rejected it, saying the accounts would not be enough to cover costs for most consumers. Currently, such accounts are used disproportionately by the wealthiest Americans, who have more income to fund them and a bigger incentive to lower their tax rate.
White House press secretary Karoline Leavitt was asked at her briefing Thursday whether the president could guarantee that under his plan, people would be able to cover their health costs. She did not directly answer, but said, “If this plan is put in place, every single American who has health care in the United States will see lower costs as a result.”
Enhanced tax credits that helped reduce the cost of insurance for the vast majority of Affordable Care Act enrollees expired at the end of 2025 even though Democrats had forced a 43-day government shutdown over the issue.
Sen. Bernie Moreno, R-Ohio, has been leading a bipartisan group of 12 senators trying to devise a compromise that would extend those subsidies for two years while adding new limits on who can receive them. That proposal would create the option, in the second year, of a health savings account that Trump and Republicans prefer.
The White House official denied that Trump was closing the door completely on those bipartisan negotiations, and said the White House preferred to send money directly to consumers.
Plan follows massive cuts to health programs
Trump’s plan comes months after the Republicans’ big tax and spending bill last year cut more than $1 trillion over a decade in federal health care and food assistance, largely by imposing work requirements on those receiving aid and shifting certain federal costs to the states.
Democrats have blasted those cuts as devastating for vulnerable people who rely on programs such as Medicaid for their health care. The GOP bill included an infusion of $50 billion over five years for rural health programs, an amount experts have said is inadequate to fill the gap in funding.
The White House said Trump’s new proposal will seek to bring down premiums by fully funding cost-sharing reductions, or CSRs, a type of financial help that insurers give to low-income ACA enrollees on silver-level, or mid-tier plans.
From 2014 until 2017, the federal government reimbursed insurance companies for CSRs. In 2017, the first Trump administration stopped making those payments. To make up for the lost money, insurance companies raised premiums for silver-level plans. That ended up increasing the financial assistance many enrollees got to help them pay for premiums.
As a result, health analysts say that while restoring money for CSRs would likely bring down silver-level premiums, as Trump says, it could have the unwelcome ripple effect of increasing many people’s net premiums on bronze and gold plans.
Lowering drug prices is a priority
Oz said Trump’s plans also seeks to have certain medications made available over the counter instead of by prescription if they are deemed safe enough. He mentioned higher-dose nonsteroidal anti-inflammatory drugs and peptic ulcer drugs as two examples.
It was unclear whether the White House is asking Congress to take steps to make more prescription drugs available over the counter. For decades, the Food and Drug Administration has had the ability to do that.
The heartburn drug Prilosec, as well as numerous allergy medications, are among those the FDA has approved for over-the-counter sales. The FDA only approves such changes if studies show patients can safely take the drug after reading the package labeling. Companies must apply for the switch.
The White House said Trump’s plan would also codify his efforts to lower drug prices by tying prices to the lowest price paid by other countries.
Trump has already struck deals with a number of drugmakers to get them to lower the prices. As part of that, the drugmakers have agreed to sell pharmacy-ready medicines directly to consumers who can shop online at the White House’s website for selling drugs directly to consumers, TrumpRx.gov.
TrumpRx did not yet have any drugs listed on Thursday. Oz said drugs will be available on the website at the end of the month.
—By Michelle L. Price and Ali Swenson, Associated Press
AP Health Writer Matthew Perrone contributed to this report.