President Trump unveiled “The Great Healthcare Plan” on January 15, 2026, calling on Congress to lower prescription drug prices, reduce insurance premiums, and increase health care price transparency. The plan proposes four main components:
- codified Most-Favored-Nation (MFN) drug pricing The administration has negotiated agreements with 16 pharmaceutical manufacturers to target prices at the lowest international level;
- Redirecting Affordable Care Act (ACA) exchange plan subsidies In the form of direct payments to consumers through health savings accounts (HSA) Instead of insurance companies;
- is restoring Cost-Sharing Reduction (CSR) funding for ACA plans; And
- Making insurance and providers mandatory price transparency, Including claim denial rate and medical loss ratio.
Some more details are available on this fact sheet.
The fiscal impact remains highly uncertain. The Committee for a Responsible Federal Budget estimates that cost-reducing provisions – primarily CSR funding restoration and PBM reform – could save approximately $50 billion over 10 years. However, if the subsidy restructuring component expands beyond increased subsidies to include base ACA premium assistance, costs could reach $350 billion over the same period. The net budgetary impact ranges from $50 billion in deficit reduction to $300 billion in deficit increase, depending on the implementation design. Remarkably, CBO has not scored the proposalBecause no legislative text exists.
It is unclear how much of the Great Healthcare Plan will actually be implemented in practice. Current law prohibits using an HSA to pay insurance premiums – only qualified medical expenses such as deductibles and co-payments. Without Congressional action to amend the Internal Revenue Code, the “direct payments to consumers” component cannot address premium affordability, the immediate crisis facing ACA enrollees after the enhanced subsidies expire on December 31, 2025. Additionally, the MFN drug pricing approach relies on voluntary manufacturer participation through the CMMI performance model (Liberal for Medicaid, Globe/Guard for Medicare Parts B/D – see my post here) rather than statutory mandates. Previous attempts to impose mandatory MFN pricing were blocked by federal courts in 2020, raising questions over enforcement authority if manufacturers refuse to participate voluntarily.
As of January 26, 2026, Congress has not introduced legislation to implement key provisions of the plan. Lawmakers passed pbm reform Last week’s appropriations legislation (H.R. 7148) delinked PBM compensation from drug prices and prohibited Medicaid spread pricing. However, Congress specifically excluded CSR funding – the single largest component of deficit reduction – from the final FY2026 appropriations package. The increased ACA subsidies were also not extended, leaving more than 20 million Americans facing an average 114% premium increase. This gap between the Administration’s stated priorities and Congressional action suggests significant political obstacles to implementation.asge+6
What are others saying about the plan? KFF CEO Drew Altman describes it as “transactional health policy” rather than comprehensive reform. The Administration has implemented several executive actions – the TrumpRx.gov direct-to-consumer platform expected to launch in January 2026, voluntary MFN agreements with manufacturers receiving three-year tariff exemptions, and the CMMI performance model – that may yield concrete but modest results for specific populations. Morningstar reports that several policy analysts described the announcement as “sparse on details”, with Raymond James stating that “there is no legislative path forward for it” and Spencer Pearlman of Veda Partners concluding that the policies “have little chance of being enacted by the current Congress…”
What do you think about the great healthcare plan?
