The Great Healthcare Plan 2026: How Trump Healthcare Reforms Could Lower Your Costs

President Donald J. Trump unveiled The Great Healthcare Plan on January 14, 2026, calling on Congress to enact comprehensive healthcare reforms targeting drug prices, insurance premiums, and price transparency. The plan proposes redirecting billions in federal subsidies from insurance companies to individual Americans, codifying Most-Favored-Nation drug pricing to match the lowest prices paid by other developed nations, and requiring health insurance companies to publish claim denial rates, overhead costs, and pricing comparisons in plain English.?

Here's what the Great Healthcare Plan is and how it differs from the current ACA structure. We also cover how Most-Favored-Nation drug pricing works and which medications could see price reductions, how direct HSA payments would replace current ACA premium subsidies, what cost-sharing reduction programs mean for Silver plan enrollees. 

What is The Great Healthcare Plan?

The Great Healthcare Plan is President Trump's framework for healthcare reform calling on Congress to pass legislation lowering prescription drug prices, reducing health insurance premiums, holding big insurance companies accountable through transparency requirements, and maximizing price transparency across the healthcare system.?

Four main pillars of The Great Healthcare Plan

The plan focuses on four areas:?

1. Lower drug prices through Most-Favored-Nation pricing, expanded over-the-counter medications, and direct-to-consumer platforms.?
2. Lower insurance premiums by redirecting subsidies to individuals, funding cost-sharing reduction programs, and eliminating pharmacy benefit manager kickbacks.?
3. Hold big insurance companies accountable by requiring plain-English insurance comparisons, publishing overhead versus claim payment percentages, and disclosing claim denial rates and wait times.?
4. Maximize price transparency by forcing Medicare and Medicaid providers to post pricing prominently in their facilities.?

How The Great Healthcare Plan lowers prescription drug prices

The plan targets prescription drug prices through three mechanisms.?

Codify Most-Favored-Nation drug pricing

The Great Healthcare Plan calls on Congress to codify the Trump Administration's Most-Favored-Nation (MFN) drug pricing deals into law. These voluntary agreements require pharmaceutical manufacturers to sell prescription drugs to Americans at the same low prices people in other countries pay.?

Since September 2025, 16 pharmaceutical companies have signed voluntary MFN agreements with the Trump Administration. The deals apply to Medicaid beneficiaries and cash-paying patients using the TrumpRx.gov direct-to-consumer platform.?

How Most-Favored-Nation pricing works

Under MFN pricing, drug manufacturers agree to align US drug prices with European price levels—specifically the lowest price among developed nations. If Germany pays $50 for a medication and the US price is $200, the manufacturer agrees to lower the US price to $50.?

The agreements cover three components:?

• Selling drugs to Medicaid at a discount matching foreign prices
• Listing new innovative drugs at the same price points in the US as in other countries
• Providing discounts for cash buyers through TrumpRx.gov

Pharmaceutical companies participating in MFN agreements receive a 3-year suspension of tariffs on imported pharmaceuticals. Companies not participating face potential tariffs as pressure to join.?

Drug companies still raised prices

Despite MFN agreements, all 16 pharmaceutical companies that signed deals with the Trump Administration raised list prices on certain medications in January 2026. The companies raised prices on 872 brand-name medications during the first two weeks of 2026.?

Why this matters: MFN agreements apply only to specific drugs sold to Medicaid or through TrumpRx.gov—not to all medications. Manufacturers can still raise list prices on drugs outside the agreement or for commercially insured patients.?

Analysts expect MFN deals to have "negligible effect on branded drug prices" for most Americans with private insurance.?

#2 Allow more over-the-counter medicines

The Great Healthcare Plan proposes making more verified safe pharmaceutical drugs available for over-the-counter purchase without prescriptions. This would lower healthcare costs by reducing the need for costly and time-consuming doctor's visits to obtain prescriptions.?

Example: Medications currently requiring prescriptions—such as certain allergy medications, acid reflux drugs, or contraceptives—could become available over-the-counter. Consumers could purchase these medications directly without paying for doctor visits.?

The plan does not specify which medications would transition to over-the-counter status or the approval process.?

#3 TrumpRx direct-to-consumer platform 

TrumpRx.gov is a federal platform launched in 2026 that enables direct consumer purchases of discounted medications from manufacturers participating in MFN agreements. The platform bypasses insurance and allows cash-paying patients to purchase drugs at European price levels.?

President Trump claimed drug costs could fall "300, 400, even 500% starting this month" via TrumpRx. However, the platform applies only to cash purchases of specific medications from participating manufacturers, not drugs covered by insurance.?

How The Great Healthcare Plan lowers insurance premiums

The plan targets health insurance premiums through three approaches.?

#1 Send money directly to Americans—not insurance companies

The most significant proposed change: The Great Healthcare Plan would stop sending federal ACA premium subsidies to insurance companies and instead deposit that money directly into individual Americans' accounts.?

President Trump stated: "The government is going to pay the money directly to you. It goes to you, and then you take the money and buy your own health care".?

How direct payments would work

Under the current ACA structure, federal premium tax credits are paid directly to insurance companies on behalf of eligible individuals. If you qualify for a $500 monthly subsidy, the government sends $500 to your insurer, reducing your premium from $900 to $400.?

The Great Healthcare Plan proposes redirecting those subsidies into Health Savings Accounts (HSAs) in consumers' names. You would receive the $500 subsidy deposited into your HSA, then use those funds to purchase health insurance of your choice.?

Why this matters: Direct payments give consumers control over which insurance to purchase—including non-ACA-compliant plans, short-term plans, or health-sharing ministries. You're not locked into ACA marketplace plans.?

Who qualifies for direct payments?

The White House stated that "eligible Americans" would receive direct payments, and "consumers outside the ACA market" would also qualify. The plan does not specify income thresholds, eligibility criteria, or payment amounts.?

Under current ACA subsidies, individuals making 100-400% of the Federal Poverty Level qualify for premium tax credits. Whether The Great Healthcare Plan maintains these income limits or expands eligibility remains unclear.?

#2 Fund cost-sharing reduction programs

The Great Healthcare Plan calls for funding a cost-sharing reduction (CSR) program for healthcare plans, which would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10%.?

What are cost-sharing reductions?

Cost-sharing reductions are subsidies that lower out-of-pocket costs like deductibles, copays, and coinsurance for individuals making 100-250% of the Federal Poverty Level who enroll in Silver plans on ACA marketplaces.?

CSRs increase the actuarial value of Silver plans:?

• 100-150% FPL: 94% actuarial value (plan covers 94% of costs)
• 150-200% FPL: 87% actuarial value
• 200-250% FPL: 73% actuarial value

Without CSRs, standard Silver plans have 70% actuarial value.?

#3 End pharmacy benefit manager kickbacks

The plan calls for ending kickbacks paid by pharmacy benefit managers (PBMs) to large brokerage middlemen that "deceptively raise the cost of health insurance".?

Pharmacy benefit managers negotiate drug prices with manufacturers on behalf of insurers and employers. PBMs receive rebates from manufacturers in exchange for favorable formulary placement—placing certain drugs on preferred tiers.?

Critics argue PBMs keep rebates as profit instead of passing savings to consumers, and that broker kickbacks further inflate insurance costs. The Great Healthcare Plan proposes banning these practices, though specific enforcement mechanisms are not detailed.?

How The Great Healthcare Plan holds insurance companies accountable

The plan imposes new transparency requirements on health insurance companies.?

Create "Plain-English Insurance" Standard

The Great Healthcare Plan requires health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English—not industry jargon. This allows consumers to compare plans easily and make informed purchasing decisions.?

Why this matters: Current insurance plan documents use complex terminology that makes comparing coverage difficult. Plain-English standards would require insurers to explain deductibles, out-of-pocket maximums, covered services, and exclusions in clear, simple language accessible to consumers without insurance expertise.?

Publish overhead costs versus claim payments

Insurers must publish the percentage of revenues paid out to claims versus overhead costs and profits on their websites.?

Example: If an insurer collects $1 billion in premiums, pays $800 million in claims, and keeps $200 million for administrative costs and profits, they must display "80% of premiums paid to claims, 20% overhead and profit" prominently on their website.?

This metric is known as the Medical Loss Ratio (MLR). ACA already requires insurers to maintain minimum MLRs—80% for individual/small group markets, 85% for large group markets. The Great Healthcare Plan would require public disclosure of actual MLRs on insurer websites.?

Display claim denial rates and wait times

Health insurance companies must publish the percentage of insurance claims they reject and average wait times for routine care on their websites.?

Why this matters: Claim denial rates vary significantly across insurers. Some insurers deny 5% of claims, while others deny 20%+. Consumers shopping for insurance have no way to know which insurers routinely deny claims until after they've enrolled and experienced denials.?

Publishing denial rates allows consumers to avoid insurers with high denial rates before purchasing coverage. Similarly, publishing average wait times for routine appointments helps consumers identify plans with adequate provider networks.?

How The Great Healthcare Plan maximizes price transparency

The plan requires healthcare providers and insurers accepting Medicare or Medicaid to prominently post pricing and fees in their facilities.?

Any healthcare provider or insurer who accepts either Medicare or Medicaid must publicly and prominently post their pricing and fees to avoid surprise medical bills.?

Example: A hospital emergency room must display prices for common services such as CT scans, X-rays, blood tests, suturing lacerations on posters in waiting areas or registration desks. An orthopedic surgeon's office must post prices for knee replacements, hip replacements, and consultations.?

This builds on existing price transparency rules implemented during Trump's first term requiring hospitals to publish machine-readable price lists. The Great Healthcare Plan extends these requirements to individual physicians, clinics, and all providers accepting Medicare or Medicaid.?

The Great Healthcare Plan and ACA premium increases in 2026

The Great Healthcare Plan arrives as millions of Americans face massive ACA premium increases for 2026.?

Why premiums jumped 114% in 2026

Enhanced ACA premium tax credits enacted during the COVID-19 pandemic expired December 31, 2025. These enhanced subsidies capped premiums at 8.5% of income for individuals making over 400% of the Federal Poverty Level—a group previously ineligible for subsidies.? Without enhanced subsidies, average premiums jumped from $888 in 2025 to $1,904 in 2026, a $1,016 monthly increase ($12,192 annually).?

Tips to prepare for The Great Healthcare Plan

Tip 1: Monitor Congressional action closely

The Great Healthcare Plan is a framework—not law. Watch for Congressional hearings, bill introductions, and committee votes on legislation implementing the plan.?

Subscribe to updates from Congress.gov, your Congressional representatives, or healthcare policy organizations like KFF to stay informed as legislation develops.?

Tip 2: Understand your current ACA subsidies

Review your current ACA premium tax credits and cost-sharing reductions. Log into Healthcare.gov and check your eligibility determination letter showing your subsidy amount.?

If The Great Healthcare Plan redirects your subsidy into an HSA, you need to know the subsidy amount to evaluate whether direct payments provide sufficient funds to purchase adequate coverage.?

Tip 3: Calculate total costs—not just premiums

When evaluating health insurance options under The Great Healthcare Plan, calculate total annual costs including premiums, deductibles, copays, coinsurance, and out-of-pocket maximums.?

A plan with a $400 monthly premium and $10,000 deductible costs more than a plan with $600 monthly premium and $2,000 deductible if you use healthcare services regularly.?

Tip 4: Don't assume over-the-counter drugs are cheaper

If more prescription medications become available over-the-counter, they may not be cheaper. Insurance plans often cover prescriptions with low copays ($10-$30). Over-the-counter versions aren't covered by insurance—you pay full retail price.?

Example: Omeprazole (Prilosec) is available both as prescription and over-the-counter. The prescription version costs a $15 copay (30-day supply). Over-the-counter version costs $25-$30 (30-day supply). The prescription is cheaper despite requiring a doctor visit.?

Tip 5: Compare TrumpRx prices to insurance-covered prices

If you're considering using TrumpRx.gov for discounted medications, compare TrumpRx cash prices to your insurance copay prices.?

TrumpRx offers discounts for cash-paying patients—but if your insurance copay is lower than the TrumpRx cash price, use insurance.?

Tip 6: Verify your provider posts prices before services

Under The Great Healthcare Plan's price transparency requirements, providers accepting Medicare or Medicaid must post prices prominently. Before receiving services, ask providers to show you posted prices for procedures, tests, or treatments.?

If a provider cannot show you prices in advance, ask for a good-faith estimate in writing before consenting to services.?

Tip 7: Research insurer claim denial rates when shopping

Once insurers publish claim denial rates on their websites, use this information when comparing plans. An insurer with 5% claim denial rates provides more reliable coverage than an insurer with 20% denial rates—even if the 20% denial insurer has lower premiums.?

High denial rates mean you'll spend time appealing denied claims and potentially paying out-of-pocket for services that should have been covered.?

Tip 8: Evaluate whether direct HSA payments benefit you

If The Great Healthcare Plan is enacted and subsidies are redirected into HSAs, evaluate whether direct payments benefit your situation.?

You may benefit if: You're healthy with low healthcare utilization and want a high-deductible plan with lower premiums. You want flexibility to choose non-ACA plans, short-term plans, or health-sharing ministries. You prefer controlling your own funds rather than having subsidies paid to insurers.?

You may not benefit if: You have chronic conditions requiring comprehensive coverage with low deductibles. You don't understand insurance terminology and need ACA protections ensuring plans cover essential benefits. You can't afford to pay premiums upfront and wait for HSA reimbursement.?

Tip 9: Don't drop coverage waiting for The Great Healthcare Plan

Do not drop current health insurance coverage assuming The Great Healthcare Plan will lower costs. The plan is not yet law, implementation timing is uncertain, and you don't know whether you'll qualify for benefits or face higher costs.?

Maintain continuous coverage to avoid gaps that trigger pre-existing condition exclusions if you need to purchase non-ACA-compliant coverage in the future.?

Tip 10: Consult a health insurance advisor or tax professional

If you're confused about how The Great Healthcare Plan might affect your coverage, consult a licensed health insurance advisor or tax professional familiar with ACA subsidies and HSA rules.?

Professional guidance helps you understand whether proposed changes benefit your specific situation and how to structure coverage to minimize costs while maintaining adequate protection.?