Washington– President Donald Trump on Thursday announced the outlines of a health care plan he wants Congress to adopt as Republicans face mounting pressure to address rising health care costs and a jump in premiums after lawmakers allowed subsidies to expire.
The cornerstone is his proposal to send money directly to Americans for health savings accounts so they can bypass the federal government and handle insurance themselves. Democrats have rejected the idea as a frivolous alternative to covering high health care costs.
“The government will pay the money directly to you,” Trump said in a recorded video released by the White House announcing the plan. “It goes to you and then you take the money and buy your health care.”
Trump has long struggled with his lack of a health care plan, as he and Republicans sought to repeal former President Barack Obama’s signature legislation, the Affordable Care Act. Trump’s efforts to repeal and replace the law were thwarted during his first term.
When he ran for president in 2024, Trump said he had only “concepts of a plan” to address health care. His new proposal, which lacks many details, appears to have been a wish list rather than ready-made legislation.
Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, described it to reporters in a conference call as “a framework that we believe will help Congress develop legislation.”
It was not immediately clear whether any lawmakers in Congress were working to advance the Republican president’s plan.
A White House official, who was not authorized to speak publicly and described some details on the condition of anonymity, said the administration was discussing the proposal with allies in Congress, but he could not name any lawmakers working to address the plan.
The White House did not provide any details about how much money it envisions sending to consumers to buy insurance or whether the money would be available to all ObamaCare enrollees or just those with lower-tier bronze and catastrophic plans.
This idea reflects an idea raised among Republican senators last year. Democrats have largely rejected the idea, saying the accounts would not be enough to cover the costs for most consumers. Currently, such accounts are disproportionately used by the wealthiest Americans, who have more income to fund and a greater incentive to lower their tax rate.
Enhanced tax credits that helped reduce the cost of insurance for the vast majority of Affordable Care Act enrollees expire at the end of 2025 even though Democrats forced a 43-day government shutdown over the issue.
Sen. Bernie Moreno, R-Ohio, is leading a bipartisan group of 12 senators trying to reach a compromise that would extend those benefits for two years while adding new limits on who can get them. This proposal would create, in year two, the health savings account option favored by Trump and Republicans.
The White House official denied that Trump was completely closing the door on bipartisan negotiations in the Senate that would temporarily extend subsidies among other changes, and said that the White House would prefer to send money directly to consumers.
Trump’s plan comes months after Republicans’ massive tax and spending bill introduced last year, which cut more than $1 trillion over a decade in federal health care and food assistance, largely by imposing work requirements on those receiving the aid and shifting some federal costs to states.
Democrats have criticized these cuts as disastrous for vulnerable people who depend on programs like Medicaid for their health care. The Republican Party bill included pumping $50 billion over five years into rural health programs, an amount that experts said was insufficient to close the funding gap.
The White House said Trump’s new proposal would seek to lower insurance premiums by fully funding cost-sharing reductions, or CSRs, a type of financial assistance that insurers provide to low-income ACA enrollees on silver-level or mid-level plans.
From 2014 through 2017, the federal government reimbursed insurers for CSR. In 2017, the first Trump administration stopped making these payments. To make up for the lost money, insurance companies have raised premiums on silver-level plans. This ended up increasing the financial assistance many enrollees received to help them pay their insurance premiums.
As a result, health analysts say that while restoring CSR funds would likely lower silver premiums, Trump says, it could have the unwelcome ripple effect of increasing net premiums for many people on bronze and gold plans.
Trump’s plans also seek to make some medications available over-the-counter rather than by prescription if deemed safe enough, Oz said. He said the change “will alleviate some of the hassle of obtaining these medications.”
He cited higher doses of NSAIDs and peptic ulcer medications as two examples.
It was not clear whether the White House was asking Congress to take steps to make more prescription drugs available without a prescription. For decades, the FDA has had the ability to do this.
The heartburn drug Prilosec, as well as several allergy medications, are among the medications approved by the FDA for sale without a prescription. The FDA approves such changes only if studies show that patients can safely take the drug after reading the label. Businesses must apply to switch.
The White House said Trump’s plan would also codify his efforts to lower drug prices by pegging prices to the lowest price other countries pay.
Trump has already struck deals with a number of drug manufacturers to get them to lower prices. As part of that, drug companies agreed to sell pharmacy-ready medications directly to consumers who can shop online at TrumpRx.gov.
The White House direct-to-consumer drug site, TrumpRx, did not list any medications yet on Thursday. Oz said the prescription medications will be available on the website at the end of the month.
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AP Health Writer Matthew Perrone contributed to this report.
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