(WASHINGTON) — On the last day to enroll in Affordable Care Act (ACA) health insurance plans in most states, President Donald Trump presented his own ideas for a health care plan that left some health policy experts that spoke to ABC News with unanswered questions.
Trump has long been asked for a health care plan amid sustained criticism of the ACA, which was signed into law by President Barack Obama. “The Great Healthcare Plan” presents a proposal to shift government insurance subsidies directly to consumers through health savings accounts and take advantage of his “most favored nation” drug price initiative.
“My plan would reduce your insurance premiums by stopping government payoffs to big insurance companies and sending that money directly to the people,” Trump said in a video announcing the plan.
However, the video and one-page fact sheet posted on the White House website were light on specifics about how much would actually go to Americans or how much funding the plan would require or how the funds would be distributed.
Dr. Sachin Jain, a former official in the Department of Health and Human Services during the Obama administration, acknowledged that it’s a “pretty big step” for Trump to articulate health care as a major priority during his second term.
Jain, who is now the president and CEO of SCAN Group and SCAN Health Plan, a not-for-profit Medicare Advantage provider, told ABC News “health care is one of these areas where the devil is always in the details” in terms of what changes could be implemented.
Aside from lowering drug prices through most-favored nation deals and cutting back on insurance subsidies, the plan proposes a cost-sharing provision that the Congressional Budget Office estimates would reduce most Obamacare premiums by 10%.
The plan also proposes to hold insurance companies accountable with a “Plain English” standard and institute pricing requirements for providers who accept Medicare and Medicaid to “prominently post their pricing and fees.”
Trump urged Congress to “pass this framework into law without delay.”
Some provisions will have ‘virtually no effect’
Some health policy experts believe with just a one-page fact sheet that there’s no way to tell how impactful these ideas could be and if they will expand on the plans already in existence through the ACA.
“Several of these provisions would have virtually no effect because they’re already in the ACA, or they look very similar to ones that are already in the ACA,” KFF Senior Vice President Cynthia Cox told ABC News.
Cox, the director of the Program on the ACA at the independent health policy research organization, stressed that Trump’s plan, in many respects, already exists, including price transparency and holding big insurance companies accountable.
Speaking about his plan, the president said Thursday that “nobody’s ever heard of” this idea to give money directly to the consumer, but Jain noted that what’s known as “consumerism” has been around for a long time.
“One of the big challenges with consumerism is health care is a complex industry to navigate, and people don’t often understand what it is that they’re buying or not buying,” Jain told ABC News.
Patients might also have a “degree of anxiety” because they don’t always know what bill they’re going to get, according to Jain.
“When it comes to true consumerism, shopping for health care isn’t like shopping for other goods and services, mostly because people don’t actually want to consume more health care,” he said.
Cox stressed that not only is giving money directly to Americans not a new proposal, it was already in multiple Republican proposals that failed to advance through the Senate in December.
Senate Health Committee Chairman Bill Cassidy argued at the time of the bill’s consideration that his legislative package would have put “thousands in patients’ pockets” to help pay for their out-of-pocket expenses. But the measure failed by a 51-48 vote just days before the expiration of the enhanced ACA tax credits.
White House officials on Thursday said Congress’ legislative plans haven’t been able to “effectuate” Trump’s desire to pay people directly for their health care costs. Without referencing any lawmakers and their existing packages specifically, the administration officials told reporters on Thursday that the White House has engaged with many Hill “allies” on the details of the president’s new plan.
Cox said she believes the president’s new strategy could also create problems for vulnerable Americans, leaving them with no option for health insurance if they don’t get it through their employer.
“One possible interpretation of this [plan] is that, you know, if you give cash to people without any requirement that they use that cash to purchase ACA marketplace coverage — or coverage that has protections for people with pre-existing conditions — then you might see that healthy people use taxpayer dollars to purchase coverage that’s not compliant with the Affordable Care Act,” Cox told ABC News.
“What that would mean is that the ACA or Obamacare markets become destabilized, possibly to the point of collapsing, which would leave people who have pre-existing conditions and who would otherwise rely on that coverage without any options,” she said.
“It could effectively do away with the pre-existing condition protection provisions of the Affordable Care Act, and at least for people who are buying their own health insurance, which is over 20 million people,” Cox added.
What’s next?
Experts suggest it’s too early to tell how soon the new proposal could impact people’s health care, especially with Congress virtually gone through Tuesday.
White House officials said the president wants Congress to codify his plan, but didn’t specify how much input congressional leaders had on the new proposal.
The House last week passed a Democratic-led bill that would see the enhanced premium tax credits extended by three years.
But a path forward that sends the legislation through the Senate to the Resolute Desk for Trump’s signature remains in question.
GOP Senate Majority Leader John Thune has said that there’s “no appetite” for an extension in the upper chamber but pointed to ongoing bipartisan talks on the extensions between senators and House members.
Since Trump’s video announcement, House Speaker Mike Johnson has vowed to continue deliberative discussions with the White House to lower health care costs for Americans.
In reference to the president’s healthcare plan, Cassidy said his Senate committee will “take action” on Trump’s affordability agenda. Republican Sen. Roger Marshall also lobbied to work with the president on a comprehensive package that includes his bill to make health care more affordable.
Still, Democratic Sen. Patty Murray blasted the plan in a post on X, writing that it took the president over a decade to come up with a health care plan that is “one entire page.”
“It will do absolutely NOTHING to stop your premiums from more than doubling,” she said.
Meanwhile, the president’s plan came on the last day to enroll in ACA health insurance plans in most states, with a few exceptions. According to government data, about 1.4 million fewer people have signed up so far this year, as premiums skyrocketed after ACA tax credits expired at the end of 2025.
Cox, at KFF, emphasized that many people could face dire consequences with the health care coverage currently available to them.
“People are really, in some cases, facing life or death decisions because they can’t afford to pay another $10,000 to keep their insurance coverage, which might mean they go uninsured,” she said.
ABC News’ Allison Pecorin and Mary Kekatos contributed to this report.
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