Overview
- President Donald Trump released a framework that would redirect money now used for enhanced ACA premium tax credits into direct payments or deposits to health savings accounts so individuals can buy their own coverage.
- The plan seeks to codify the administration’s most-favored-nation drug-price agreements and expand self-pay options, including more over-the-counter medicines and the TrumpRx platform.
- The White House says it would fully fund cost-sharing reductions, citing Congressional Budget Office estimates of $36 billion in taxpayer savings and premium cuts of more than 10%, though analysts note restoring CSRs could shift costs across plan tiers.
- Insurers and providers would face expanded transparency rules, including posting prices, claim-denial rates, average wait times, and the share of premiums spent on care versus profits, with compliance required for those participating in Medicare or Medicaid.
- Congress has not coalesced around legislation as Senate talks on reviving expired ACA subsidies continue after a House vote for a three-year extension, with experts and Democrats warning the HSA/direct-payment approach may not improve affordability and CMS data showing enrollment declines and higher premiums after the subsidy lapse.