President Trump unveiled “The Great Healthcare Plan” on January 15, 2026, calling on Congress to reduce prescription drug prices, lower insurance premiums, and increase healthcare price transparency. The plan proposes four main components:
codifying Most-Favored-Nation (MFN) drug pricing agreements that the administration has negotiated with 16 pharmaceutical manufacturers, targeting prices at the lowest international levels;Redirecting Affordable Care Act (ACA) exchange plan subsidies as direct payments to consumers via Health Savings Accounts (HSA) rather than to insurance companies; Restoring Cost-Sharing Reduction (CSR) funding for ACA plans; and Mandating insurance and provider price transparency, including claims denial rates and medical loss ratios.
Some more details are available at 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 reforms—could save approximately $50 billion over 10 years. However, if the subsidy restructuring component extends beyond enhanced subsidies to include base ACA premium assistance, costs could reach $350 billion over the same period. The net budgetary effect ranges from $50 billion in deficit reduction to $300 billion in deficit increase depending on implementation design. Notably, CBO has not scored the proposal, as no legislative text exists.
It is unclear how much of the Great Healthcare Plan will actually be implemented in practice. Current law prohibits using HSAs to pay insurance premiums—only qualified medical expenses such as deductibles and copayments. Without Congressional action to amend the Internal Revenue Code, the “direct payments to consumers” component cannot address premium affordability, which is the immediate crisis facing ACA enrollees after enhanced subsidies expired December 31, 2025. Additionally, the MFN drug pricing approach relies on voluntary manufacturer participation through CMMI demonstration models (GENEROUS 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 about enforcement authority if manufacturers decline to participate voluntarily.
As of January 26, 2026, Congress has not introduced legislation to implement the plan’s core provisions. Lawmakers did pass PBM reforms in appropriations legislation (H.R. 7148) last week, delinking PBM compensation from drug prices and prohibiting Medicaid spread pricing. However, Congress notably excluded CSR funding—the single largest deficit-reducing component—from the final FY2026 appropriations package. Enhanced ACA subsidies were also not extended, leaving 20+ million Americans facing premium increases averaging 114%. This disconnect 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 as “health policy by transaction” rather than comprehensive reform. The administration has implemented several executive actions—the TrumpRx.gov direct-to-consumer platform expected to launch January 2026, voluntary MFN agreements with manufacturers receiving three-year tariff exemptions, and CMMI demonstration models—that may produce tangible but modest results for specific populations. Morningstar reports that multiple policy analysts characterized the announcement as “sparse on details,” with Raymond James noting “there is no legislative path forward for much of it” and Spencer Perlman of Veda Partners concluding the policies “stand little chance of being enacted by the current Congress…”
