President Donald Trump addresses the Detroit Economic Club at the MotorCity Casino on January 13, 2025. (Photo by Ben Solis/Michigan Advance)
WASHINGTON – President Donald Trump presented his health care proposals to Congress on Thursday, asking lawmakers to “immediately” approve several sweeping policy changes – but omitted any mention of increased tax credits, the expiration of which has left some Americans with skyrocketing costs.
Health care costs, especially rising health insurance prices, became a habitual topic of conversation for politicians in both political parties after last year’s government shutdown, when Democrats repeatedly called on Republicans to extend the now-expired enhanced tax credits for marketplace plans under the Affordable Care Act.
Trump repeated in five-minute video that he wants Congress to give money directly to Americans so they can utilize it to pay for health insurance or health care, a proposal that has so far failed to gain the traction needed to advance on Capitol Hill.
Trump did not detail any income limits for the direct payments, which would likely be sent to health care savings accounts instead of a regular check. He also didn’t say how much per month or year he wants lawmakers to give Americans, leaving that to members of Congress to determine.
“The government will pay the money directly to you. It will go to you, and then you take the money and buy your own health care,” Trump said. “No one has heard of this before and that’s what it is. The big insurance companies are losing and the people of our country are winning.”
The ACA’s enhanced marketplace tax credits, first implemented by Democrats during the coronavirus pandemic, expired at the end of 2025. The subsidies have helped keep premiums lower than for the roughly 22 million Americans covered by these health insurance plans.
Earlier this month, the House voted to keep the increased tax breaks in place for another three years, but the bill stalled in the Senate as a bipartisan group of lawmakers tries to reach consensus for the next two years of the subsidy with significant changes.
Lower drug prices
In the video, Trump said Congress should approve legislation requiring prescription drug companies to ensure that Americans pay the lowest price in the world for their drugs. It’s a policy known as “most favored nation” that he pursued during his second term.
“So instead of paying Americans the highest drug prices in the world, which we have for decades, we will now pay the lowest costs that any other nation pays,” he said. “So every other nation that pays the lowest cost, that’s what we’ll pay. And the American people will get the savings.”
Trump said the legislative proposal, which he called the “Big Health Care Plan,” would require insurance companies and health care providers to make easy-to-understand information publicly available about what they charge and what profits they make.
“As the saying goes, sunlight is the best disinfectant. That’s why my plan requires all insurance companies to publish rate and coverage comparisons in very plain English,” Trump said. “This requires insurers to publish details of how much of the money they intend to pay out in claims compared to the amount they make in profits.”
He added that insurance companies will have to detail how many claims they deny and whether those denials of payment for health care have been overturned on appeal.
“Most importantly, any hospital or insurer that accepts Medicare or Medicaid will require each hospital or insurer to post all prices prominently in its place of business so that you are never surprised and can easily shop for a better deal or better care,” Trump said. 2019 rule created similar requirement. “We will have maximum price transparency and costs will drop tremendously.”
The road through Congress
AND one-page outline proposal posted on the White House website does not specify whether Trump wants Congress to approve policy proposals through the complicated budget reconciliation process that Republicans used to approve a “big, beautiful” bill this summer, or to negotiate a bipartisan bill with Democrats.
A White House official, talking about the past during a call with reporters to discuss the plan and next steps in detail, said the administration believes “all of the proposals have the broad support of the American people.”
“We expect both Republicans and Democrats to be able to pass it, so reconciliation would not be necessary,” the official said.
The framework is intended to give lawmakers “broad direction,” leaving negotiators free to take up any bill they write in a different direction, the official said, adding that the administration is “open to working” with Congress on the details.
“We want to make progress,” the official said. “We are not setting a specific path.”
The official said the president’s omission of any mention of the expired enhanced tax credits for people who buy health insurance through the Affordable Care Act platform was not intended to interrupt ongoing bipartisan talks in the Senate.
“This does not specifically address ongoing bipartisan negotiations in Congress,” the official said. “It says we would rather the money go to the people, not the insurance companies.”
Engaging drug manufacturers
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz said on the same call with reporters that the administration believes a framework focusing on “four pillars” needs to be codified into law – solidifying drug prices in most-favored-nation countries, lowering health insurance costs, ensuring transparency from health insurance companies and getting more pricing information from health care providers.
“While we at CMS are taking serious actions, including financial penalties and the like, it’s important for Congress to say, ‘This is what it will be, this is the law,’” Oz said, adding that he truly believes at least some of the proposals could garner bipartisan support.
Oz said the administration’s approach of lowering prescription drug costs to the lowest levels offered anywhere in the world is not intended to impede innovation and reiterated that legislating is critical to long-term stability.
“We believe that by codifying this we will ensure that pharmaceutical companies remain committed to future administrations,” Oz said. “We also believe that by doing this properly, we will not overstep boundaries and create challenges for the lifesaving medicines that are continually being developed and advanced in the United States.”
The Trump administration, he said, wants Congress to give the Food and Drug Administration more freedom to turn prescription drugs into over-the-counter drugs, which could raise competition and lower prices.
Oz said the price transparency portion of the proposal would facilitate Americans have more information about the time it takes for routine visits and whether insurance companies are able to keep rates low by frequently denying claims.
