WASHINGTON — President Donald Trump on Thursday announced the outlines of a health care plan he wants Congress to take up, centering on direct government payments to Americans for health savings accounts and steps to lower prescription drug prices, as Republicans face pressure after enhanced Affordable Care Act subsidies expired at the end of 2025.
The White House released a taped video in which Trump described the plan’s core mechanism. “The government is going to pay the money directly to you,” Trump said. “It goes to you and then you take the money and buy your own health care.”
The proposal, short on many specifics by the administration’s own acknowledgment, arrives months after a Republican spending bill cut more than $1 trillion in federal health and food assistance over a decade, and while a bipartisan Senate group works separately on extending the expired ACA subsidies.
Savings accounts at the center, details scarce
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, described the proposal to reporters as “a framework that we believe will help Congress create legislation.”
The White House did not offer details about how much money it envisioned sending to consumers for health savings accounts, or whether the accounts would be available to all Affordable Care Act enrollees or only those in lower-tier bronze and catastrophic plans.
A White House official who was not authorized to speak publicly described some details on condition of anonymity, saying the administration had discussed the proposal with congressional allies — but was unable to name any lawmakers working on the plan.
Sen. Bill Cassidy of Louisiana, chair of the Senate health committee, praised the proposal in a social media post, saying his committee “has and will take action on the President’s affordability agenda.”
Democrats push back; bipartisan subsidy talks continue
Democrats have largely rejected the health savings account approach as an inadequate substitute for the ACA tax credits that had helped lower monthly premiums for most enrollees. Health savings accounts are currently used disproportionately by wealthier Americans, who have more income to fund them and a larger incentive to lower their tax rate, according to the Associated Press.
White House press secretary Karoline Leavitt did not directly answer when asked whether the president could guarantee that Americans would be able to cover their health costs under the plan. “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,” she said.
A separate bipartisan group of 12 senators, led by Sen. Bernie Moreno of Ohio, has been working on a compromise that would extend the expired subsidies for two years while adding new limits on eligibility. That proposal would include, in its second year, the option of a health savings account that Trump and Republicans prefer. The White House denied it was closing the door completely on those negotiations.
Drug prices, transparency, and over-the-counter access
Trump’s plan also seeks to lower drug prices by codifying his administration’s efforts to tie U.S. prices to the lowest price paid by other countries. The White House said Trump has already struck deals with a number of drugmakers to lower prices, and as part of those arrangements, the companies have agreed to sell pharmacy-ready medicines directly to consumers through TrumpRx.gov, a White House direct-sales website. The site had no drugs listed as of Thursday. Oz said drugs would be available on the website by the end of the month.
Oz said the plan also seeks to make certain medications available over the counter without a prescription, citing higher-dose nonsteroidal anti-inflammatory drugs and peptic ulcer drugs as examples. The Food and Drug Administration has long had authority to approve such switches after applicants demonstrate patient safety through labeling alone; companies must apply for the change.
The plan would additionally require insurers to be more transparent about costs, revenues, rejected claims, and wait times for care.
CSR restoration carries trade-offs, analysts say
The White House said the plan would fully fund cost-sharing reductions — financial assistance that insurers provide to low-income ACA enrollees on silver-level plans. The federal government reimbursed insurers for those reductions from 2014 until 2017, when the first Trump administration stopped making those payments. Insurers responded by raising silver-plan premiums, which in turn increased the premium subsidies many enrollees received to help them pay for coverage.
Health analysts said that while restoring the funding would likely bring down silver-plan premiums as Trump has said, it could have the unwelcome ripple effect of increasing net premiums for enrollees on bronze and gold plans.
Background: cuts preceded the announcement
Thursday’s announcement came months after Republicans’ large tax and spending bill cut more than $1 trillion over a decade in federal health care and food assistance, largely by imposing work requirements on aid recipients and shifting certain costs to states. Democrats said those cuts harm vulnerable people who rely on programs such as Medicaid. The bill included $50 billion over five years for rural health programs, an amount health experts said is inadequate to fill the gap.
Trump was thwarted during his first term in attempting to repeal and replace the Affordable Care Act. During his 2024 campaign, Trump said he had only “concepts of a plan” to address health care.