Trump unveils framework on health care costs

WASHINGTON — President Donald Trump outlined his health care proposals to Congress on Thursday, asking lawmakers to approve several broad policy changes "without delay" — but left out any mention of enhanced tax credits whose expiration has left some Americans with skyrocketing costs.

Health care costs, especially the rising price of health insurance, have become a frequent talking point for politicians from both political parties following last year's government shutdown, when Democrats repeatedly called on Republicans to extend the now-expired enhanced tax credits for Affordable Care Act marketplace plans.

Trump reiterated in a five-minute video that he wants Congress to give Americans money directly so they can use it to offset the cost of health insurance or health care, a proposal that has so far been unable to get the traction needed to advance on Capitol Hill.

Trump didn't detail any income caps on the direct payments, which would likely be sent to Health Savings Accounts as opposed to a simple check. He also didn't say how much per month or annually he wants lawmakers to provide Americans, leaving it for members of Congress to hash out.

"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," Trump said. "Nobody has ever heard of that before, and that's the way it is. The big insurance companies lose and the people of our country win."

The enhanced ACA marketplace tax credits, first implemented by Democrats during the coronavirus pandemic, expired at the end of 2025. The subsidies helped to keep premiums lower than they would have otherwise been for about 22 million Americans on those health insurance plans.

The House voted earlier this month to keep the enhanced tax credits going for another three years, but the bill has stalled in the Senate as a bipartisan group of lawmakers tries to reach consensus on two more years of the subsidies with significant changes.

Lower drug prices

Trump said in the video that Congress should approve legislation that requires prescription drug companies to ensure Americans pay the lowest price in the world for pharmaceuticals, a policy known as "most favored nation" that he has pursued during his second term.

"So instead of Americans paying the highest drug prices in the world, which we have for decades, we will now be paying the lowest cost paid by any other nation," he said. "So any other nation that's paying the lowest cost, that's what we're going to pay. And the American people will get the savings."

Trump said the legislative request, which he dubbed "The Great Health Care Plan," would require health insurance companies and health care providers to publicly share easy-to-understand information about what they charge and how much they make in profit.

Path through Congress

A one-page outline of the proposal posted to the White House website doesn't detail whether Trump wants Congress to approve the policy requests through the complex budget reconciliation process that Republicans used to approve the "big, beautiful" law this summer or to negotiate a bipartisan bill with Democrats.

A White House official, speaking on background on a call with reporters to detail the plan and the next steps, said the administration believes the "proposals all have broad support from the American people."

"We expect both Republicans and Democrats to be able to embrace them, so reconciliation would not be necessary," the official said.

Engaging drugmakers

Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said on the same call with reporters that the framework focused on "four pillars" the administration believes must be codified into law — solidifying most favored nation drug pricing, lowering health insurance costs, transparency from health insurance companies and more pricing information from health care providers.

"Although we're taking major action at CMS, including fines and the like, having Congress say, 'This is how it's going to be, this is a law of the land' is important," Oz said, adding that he really does believe there can be bipartisan support for at least some of the proposals.

Oz said the administration's approach to bring down the cost of prescription drugs to the lowest level offered anywhere in the world is not intended to impede innovation and reiterated that lawmaking is crucial for longer-term stability.