WASHINGTON (AP) — President Donald Trump on Thursday announced the outlines of the health care plan he wants Congress to pass, as Republicans face mounting pressure to address rising health care costs after lawmakers let subsidies expire.
The cornerstone is his proposal to send money directly to Americans for health savings accounts so they can manage insurance and health costs as they see fit. Democrats dismissed the idea as a poor substitute for tax credits that helped lower monthly premiums for many people.
“The government will pay your money directly,” Trump said in a White House video released to announce the plan. “It goes to you and then you take the money and buy your own health care.”
Trump’s plan also focuses on lowering drug prices and forcing insurers to be more honest with the public about costs, revenues, denied claims and wait times for care.
Trump has long been dogged by the lack of a comprehensive health care plan as he and Republicans sought to undo former President Barack Obama’s signature legislation, the Affordable Care Act. Trump was stymied during his first term in trying to repeal and replace the law.
When he ran for president in 2024, Trump said he had only the “concepts of a plan” to address health care. His new proposal, short with many details, seemed to be the concepts of a plan.
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, described it to reporters in a telephone briefing as “a framework that we believe will help Congress create legislation.”
It was not immediately clear whether lawmakers in Congress were working to introduce the Republican president’s plan. A White House official who was not authorized to speak publicly and described few details on condition of anonymity said the administration had discussed the proposal with allies in Congress but was unable to name any lawmakers working to address the plan.
A few details about health savings accounts
The White House did not provide details on how much money it plans to send to consumers to shop for insurance, or whether the money will be available to all Obamacare enrollees or just those with lower-tier bronze and catastrophic plans.
The idea mirrors one of Republican senators last year. Democrats largely rejected it, saying the bills wouldn’t be enough to cover the costs for most consumers. Currently, such accounts are used disproportionately by the wealthiest Americans, who have more income to fund them and a greater incentive to lower their tax rate.
White House press secretary Karoline Leavitt was asked at her briefing Thursday whether the president could guarantee that under his plan people would be able to cover their health care costs. She did not answer directly, but said, “If this plan is implemented, every American who has health care in the United States will see lower costs as a result.”
Enhanced tax credits that helped lower the cost of insurance for the vast majority of Affordable Care Act enrollees expired at the end of 2025, even as Democrats forced a 43-day government shutdown over the issue.
Sen. Bernie Moreno, R-Ohio, led a bipartisan group of 12 senators trying to find a compromise that would extend those grants for two years while adding new limits on who can receive them. That proposal would create the option, in the second year, of a health savings account that Trump and Republicans prefer.
The White House official denied that Trump was completely closing the door on these bipartisan negotiations and said the White House preferred to send money directly to consumers.
The plan follows massive cuts to health care programs
Trump’s plan comes months after the Republicans’ big tax-and-spending bill slashed more than $1 trillion in federal health and food assistance last year, largely by imposing work requirements on those receiving aid and shifting some federal costs to states.
Democrats have seen the cuts as devastating to vulnerable people who rely on programs like Medicaid for their health care. The GOP bill included an infusion of $50 billion over five years for rural health programs, an amount experts said was inadequate to fill the funding gap.
The White House said Trump’s new proposal would try to lower premiums by fully funding cost-sharing reductions, or CSRs, a type of financial help that insurers offer to low-income ACA enrollees in silver or mid-level plans.
From 2014 to 2017, the federal government reimbursed insurance companies for CSR. In 2017, the first Trump administration stopped making those payments. To make up for the lost money, insurance companies raised premiums for silver-level plans. This ended up increasing the financial assistance many enrollees received to help pay their premiums.
As a result, health analysts say that while restoring money for CSRs would likely reduce premiums to silver levels, as Trump says, it could have the unintended effect of raising many people’s net premiums on bronze and gold plans.
Lowering drug prices is a priority
Oz said Trump’s plans also call for certain drugs to be made available over the counter, not by prescription, if they are deemed safe enough. He cited higher-dose NSAIDs and peptic ulcer medications as two examples.
It was unclear whether the White House is asking Congress to take action to make more prescription drugs available. For decades, the Food and Drug Administration has had the ability to do this.
The heartburn drug Prilosec, as well as numerous allergy medications, are among those approved by the FDA for over-the-counter sales. The FDA approves such changes only if studies show that patients can take the drug safely after reading the package label. Companies must request the change.
The White House said Trump’s plan would also codify his efforts to lower drug prices by tying prices to the lowest price paid by other countries.
Trump has already struck deals with a number of drugmakers to get them to lower prices. As part of that, drugmakers have agreed to sell pharmacy-ready drugs directly to consumers who can shop online from the White House’s direct-to-consumer drug sales website, TrumpRx.gov.
TrumpRx did not yet have any drugs listed on Thursday. Oz said the drugs will be available on the site at the end of the month.
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AP Health writer Matthew Perrone contributed to this report.