Trump 'Great Healthcare Plan' Sends Payments to HSAs but Leaves ACA Subsidy Void Unclear
President Trump’s "Great Healthcare Plan" is a high‑level four‑pillar framework — drug pricing, insurance reforms, price transparency and fraud protections — that the White House says would redirect federal payments “directly to you,” potentially by routing funds into health savings accounts (HSAs), but it provides no legislative text or operational details. Experts and Democrats warn it does not address the lapse of enhanced ACA premium subsidies and could leave lower‑income and ACA enrollees worse off, since HSAs skew to higher‑income users and the approach could encourage non‑comprehensive coverage that undermines ACA protections.
📌 Key Facts
- The White House rolled out the "Great Healthcare Plan" as a broad four‑pillar framework — drug price reforms, insurance reforms, price transparency, and fraud protections — but released no detailed policies, legislative text, or operational mechanisms.
- President Trump and administration officials repeatedly said "the government is going to pay the money directly to you," and the White House indicated those funds could be routed into health savings accounts (HSAs) while offering no specifics on how payments would be delivered or administered.
- The administration framed the approach as stopping "government payoffs to big insurance companies" under the ACA and sending that money "directly to the people;" spokeswoman Karoline Leavitt also claimed "every single American who has health care in the United States will see lower costs," a sweeping promise without supporting detail.
- Price‑transparency measures were highlighted (including requiring hospitals to prominently post prices so patients can shop), but the plan provides no concrete implementation guidance for these or other proposals.
- News outlets emphasize the plan does not provide a remedy for people facing steep ACA premium increases after the lapse of enhanced premium subsidies; that lapse has been linked to sharp premium hikes and roughly 14 million fewer ACA enrollees compared with last year.
- The White House and CMS could not name any specific lawmakers currently drafting legislation to implement the framework; CMS Administrator Dr. Mehmet Oz publicly called it a "framework," repeatedly deferred on specifics, and left detailed questions to anonymous White House staff.
- Policy experts and Democrats warn HSAs are disproportionately used by higher‑income Americans and would likely be insufficient for typical ACA enrollees; critics also say orienting federal dollars toward buying non‑comprehensive plans could undercut ACA benefit standards and weaken HealthCare.gov.
- Some bipartisan senators reacted publicly: Sen. Bernie Moreno praised the plan and said its omission of enhanced subsidies does not derail bipartisan talks, while Sen. Lisa Murkowski said she remains committed to extending subsidies as families face higher premiums or the choice of going uninsured.
📊 Relevant Data
In 2026, if enhanced ACA premium tax credits expire, the number of uninsured nonelderly Non-Hispanic White people is projected to increase by 2.3 million, raising the uninsured rate from 6.5% to 8.1%, a 25% increase, while Non-Hispanic White people make up about 58.9% of the US population.
4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire — Urban Institute
In 2026, if enhanced ACA premium tax credits expire, the number of uninsured nonelderly American Indian/Alaska Native people is projected to increase by 125,000, raising the uninsured rate from 20.6% to 24.3%, an 18% increase, while American Indian/Alaska Native people make up about 0.9% of the US population.
4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire — Urban Institute
In tax year 2023, 77% of the total value of HSA contributions went to individuals with incomes over $100,000, and in tax year 2019, 78% of HSA participants who maximized contributions had incomes over $100,000.
Expanding Health Savings Accounts Would Boost Tax Shelters, Not Access to Care — Center on Budget and Policy Priorities
Among privately insured people in the US, Latino and Black individuals are about half as likely to have Health Savings Accounts as White and Asian individuals.
Expanding Health Savings Accounts Would Boost Tax Shelters, Not Access to Care — Center on Budget and Policy Priorities
In 2023, among people under age 65, uninsured rates were 19% for American Indian or Alaska Native adults, 18% for Hispanic adults, 13% for Native Hawaiian or Pacific Islander adults, 10% for Black adults, 7% for White adults, and 6% for Asian adults.
Key Data on Health and Health Care by Race and Ethnicity — KFF
📰 Source Timeline (5)
Follow how coverage of this story developed over time
- NPR confirms the White House has released a formal fact sheet laying out four pillars of the 'Great Healthcare Plan': drug price reforms, health insurance reforms, price transparency, and fraud protections/safeguards.
- NPR’s health correspondent notes explicitly that the plan does not mention repealing the ACA and characterizes the document as a 'greatest hits' compilation of prior Republican health policy ideas, with no new operational detail.
- The story emphasizes that the framework appears oriented toward letting people use federal dollars to buy non‑comprehensive coverage, which would undercut ACA‑style benefit standards and potentially weaken HealthCare.gov.
- PBS/AP provides Trump’s own taped quote that 'The government is going to pay the money directly to you,' clarifying the HSA‑first design.
- Karoline Leavitt explicitly claims at the podium that 'every single American who has health care in the United States will see lower costs as a result,' a sweeping promise not previously quoted at that breadth.
- CMS Administrator Dr. Mehmet Oz publicly characterizes the proposal as a 'framework' to help Congress write legislation and concedes it is not a detailed plan.
- The article confirms the White House cannot name any specific lawmakers currently drafting a bill to implement the framework.
- AP details that current HSAs are disproportionately used by higher‑income Americans and notes Democrats’ concern that accounts would be insufficient for typical ACA enrollees.
- NPR details that the 'Great Healthcare Plan' is a broad four‑pillar framework (drug price reforms, insurance reforms, price transparency, fraud protections) with no concrete provisions yet and no remedy for people now facing huge ACA premium hikes after enhanced subsidies lapsed.
- CMS chief Dr. Mehmet Oz, leading the rollout, explicitly characterizes the plan as a 'broad framework' and deflects questions on specific policies to anonymous White House staff, who also decline to provide detail.
- KFF ACA expert Cynthia Cox says the plan looks like a grab bag of long‑standing Republican ideas, some already in the ACA, and 'doesn't appear to address the rising premium payments that we're seeing.'
- Sen. Bernie Moreno, the lead GOP negotiator on a bipartisan Senate bill to revive enhanced ACA subsidies, publicly praises Trump’s plan and insists its omission of subsidies does not derail negotiations, while blaming Senate Democratic leadership for the current impasse.
- Sen. Lisa Murkowski says she is 'not giving up' on a bipartisan subsidy extension and stresses that on the last day of open enrollment families are choosing between sharply higher premiums and going uninsured.
- CBS quotes Trump saying, "The government is going to pay the money directly to you... then you take the money and buy your own health care," and claiming "nobody has ever heard of that before."
- The White House tells CBS the money under the plan could be routed into health savings accounts, but offers no operational details.
- Trump explicitly frames the plan as stopping 'government payoffs to big insurance companies' under Obamacare and sending that money 'directly to the people.'
- The article notes the plan would require hospitals to "prominently post all prices" so patients are "never surprised" and can shop for "a better deal or better care."
- CBS ties the rollout directly to the lapse of enhanced ACA premium subsidies, which has produced sharp premium hikes and about 14 million fewer ACA enrollees compared with last year, and to a pending Senate vote on extending those subsidies.