With both houses of Congress unable to codify some plan to address the evaporating premium supports under the ACA (COVID era addition), President Trump put forth his framework known as The Great Healthcare Plan. For more on the ACA extension/premium supports and related Congressional plans/details, see my earlier post here: https://rhislop3.com/the-aca-subsidies-where-we-are-whats-next/
On January 15, the Trump healthcare policy framework with details on several significant proposals aimed at reforming drug pricing, insurance costs, and price transparency within the U.S. healthcare system was released. While the plan introduces notable changes, it does not provide comprehensive details regarding the implementation or enforcement of its provisions. Below is a structured overview of the three primary areas addressed in the framework. The Great Healthcare Plan – The White House
A video President Trump discussing the plan is available here: https://youtu.be/fUzNupJidq4
1. Drug Pricing
The “Great Healthcare Plan” seeks to formalize the administration’s “most-favored-nation” pricing model, which links the cost of drugs in the United States to the lowest prices paid by peer nations. This approach maintains recent agreements made by the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) with major pharmaceutical companies. Since September, 16 out of the 17 largest drug manufacturers—including Pfizer, Eli Lilly, and Sanofi—have entered into voluntary agreements to apply this pricing model to portions of their portfolios. Regeneron remains the only major company yet to reach an agreement.
Discounted medications, including treatments for cancer, Type 2 diabetes, rheumatoid arthritis, HIV, hepatitis B and C, and asthma, will be made available at these negotiated prices through TrumpRx, a new federal direct-to-consumer website that is expected to launch later this month. Several agreements specifically include substantial discounts on insulin and GLP-1 drugs used for diabetes and obesity. Under these arrangements, drugmakers will provide Medicaid medications at the most-favored-nation pricing.
Additionally, Eli Lilly and Novo Nordisk have agreed to supply Ozempic, Wegovy, Mounjaro, and Zepbound to Medicare using CMS’s new voluntary BALANCE model, which will facilitate access to GLP-1 drugs in conjunction with complimentary lifestyle programs.
This announcement coincides with Medicare’s initial implementation of negotiated drug prices under the Inflation Reduction Act, which caps costs for ten high-expenditure Medicare Part D drugs as of January 1. A December Vizient report noted that manufacturers had accelerated price increases for Parts B and D products after the law’s passage in 2022, in anticipation of these regulations.
2. Insurance Costs
In the insurance sector, the framework proposes eliminating direct Affordable Care Act (ACA) subsidy payments to insurers. Instead, the funds would be sent directly to eligible Americans to help them purchase coverage. However, the proposal does not specify how these payments would be made or whether the purchased plans would be required to meet ACA standards, such as protections for preexisting conditions.
Some Republican policymakers are advocating for health savings accounts (HSAs) as an alternative to renewing enhanced ACA subsidies, which expired in late 2025. Pending Senate draft legislation suggests that an HSA option may be introduced in the second year of a proposed two-year extension, though this legislation is not expected to be finalized until the end of January.
The framework also calls for renewed funding for cost-sharing reductions (CSRs), reversing the practice implemented since 2017 when federal CSR payments were discontinued during the previous Trump administration. This led insurers to increase silver plan premiums through a process known as “silver loading.” The new initiative claims it could save at least $36 billion and reduce standard ACA plan premiums by more than 10%.
Additional transparency mandates would require insurers to publish plain-language rate and coverage comparisons, claim denial rates, average wait times, and the ratio of claims paid to overhead and profit on their websites. The plan also includes a provision aimed at addressing pharmacy benefit manager (PBM) kickbacks to brokers.
Marketplace enrollment is projected to decline to 22.8 million for 2026, according to preliminary CMS data. Recent House-passed legislation for a three-year subsidy extension is stalled in the Senate, and President Trump has stated he may veto such measures. Congressional scrutiny of insurers is increasing, with hearings scheduled for January 22 involving executives from UnitedHealth, CVS Health, Elevance, Cigna, and Ascendiun before key House committees. The president has also expressed plans to meet with 14 insurers to discuss industry profits.
3. Price Transparency
The framework stipulates that all healthcare providers and insurers accepting Medicare or Medicaid must clearly disclose their pricing and fees at their locations. Federal price transparency laws have applied to hospitals since January 1, 2021, and to payers since July 1, 2022. Since these requirements took effect, 27 hospitals have been fined for noncompliance, with penalties ranging from $32,301 to $979,000. To date, no payers have been fined, even though research points to significant gaps in published data.
Two updates to price transparency policies are scheduled for 2026. Beginning February 2, payers will be required to update machine-readable files to the schema 2.0 format, which aims to improve price context and reduce data size. Hospitals will face changes effective April 1, focusing on executive accountability, new percentile allowed amount reporting requirements, and mandatory National Provider Identifier reporting.
In December, CMS proposed additional updates that would require insurers to streamline pricing data, shift reporting from monthly to quarterly, and enhance price comparison tools to improve consumer accessibility.
4. Next Steps
The plan requires congressional action to become law, as it lacks specific legislative text and relies on lawmakers to codify its elements.
Here’s the anticipated timeline and process based on current developments:
- House Review and Debate (This Week): On January 20, 2026, congressional leaders released the remaining FY 2026 appropriations bills (a “minibus” package including Labor-HHS, Defense, Homeland Security, and Transportation-HUD). This includes a bipartisan healthcare title with extensions for key programs like Medicare-dependent hospitals (1 year), telehealth flexibilities (2 years), and the Acute Hospital Care at Home waiver (5 years), plus a permanent extension for the 9/11 World Trade Center Health Program.
The House Rules Committee is expected to set debate rules soon, with floor consideration potentially starting as early as January 22, 2026, before the House recesses. However, this package does not fully incorporate Trump’s broader plan, such as Most-Favored-Nation drug pricing or direct payments and may face pushback from fiscal conservatives over spending levels.
- Senate Action (Late January): If the House passes the minibus, it heads to the Senate for consideration. Bipartisan Senate talks on a separate ACA subsidy extension (potentially 2 years with an HSA option) are ongoing but stalled, with a draft not expected until late January.
Trump’s plan could influence or compete with these efforts, though he has hinted at vetoing subsidy extensions without his preferred policies.
- Government Funding Deadline (January 30): Lawmakers aim to pass the package before this date to avert a partial shutdown, which could pressure inclusion of healthcare provisions. Trump’s plan elements might be negotiated into the final bill, but key parts like Most-Favored-Nation pricing face GOP opposition.
- Potential Challenges and Alternatives: The plan’s fate hinges on Republican unity, as senior GOP members have expressed reservations about linking U.S. drug prices to foreign rates.
5. Legislative Path Forward
The proposed plan requires formal congressional action to become law, as it currently lacks specific legislative text and depends on lawmakers to codify its various elements.
House Review and Debate
On January 20, 2026, congressional leaders introduced the remaining FY 2026 appropriations bills as part of a “minibus” package, which encompasses key areas such as Labor-HHS, Defense, Homeland Security, and Transportation-HUD. This legislative package features a bipartisan healthcare section that includes temporary and permanent extensions for several essential programs: Medicare-dependent hospitals (1 year), telehealth flexibilities (2 years), the Acute Hospital Care at Home waiver (5 years), and a permanent extension for the 9/11 World Trade Center Health Program.
The House Rules Committee is anticipated to establish the rules for debate shortly, with the possibility of floor consideration beginning as early as January 22, 2026, ahead of the House’s scheduled recess.
It is important to note that this appropriations package does not fully embody the broader healthcare plan proposed by President Trump. Notably, provisions such as Most-Favored-Nation drug pricing and direct payment models are absent. Additionally, there may be resistance from fiscal conservatives concerned about overall spending levels.
Senate Action
Should the House approve the minibus package, it will proceed to the Senate for further consideration. In the Senate, bipartisan discussions continue regarding a separate extension of ACA subsidies, possibly for two years and potentially including a health savings account (HSA) option. However, these negotiations remain stalled, and a draft proposal is not anticipated until late January.