President Donald Trump addresses the Detroit Economic Club at the MotorCity Casino on Jan. 13, 2025. (Photo by Ben Solis/Michigan Advance)

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.  

“As the saying goes, sunlight is the best disinfectant. That is why my plan orders all insurance companies to publish rate and coverage comparisons in very plain English,” Trump said. “It requires insurers to publish detailed information about how much of your money they’re going to be paying out in claims versus how much they’re taking in in profits.” 

Health insurance companies, he said, would be required to detail how many claims they deny and whether those refusals to pay for health care were overturned on appeal. 

“And most importantly, it will require any hospital or insurer who accepts Medicare or Medicaid to prominently post all prices at their place of business so that you are never surprised and you can easily shop for a better deal or better care,” Trump said, though a 2019 rule created a similar requirement. “We will have maximum price transparency and costs will come down incredibly.”

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.

The framework is intended to provide “broad direction” to lawmakers, leaving negotiators the ability to take any bill they may write in different directions, the official said, adding the administration is “open to working” with Congress on the details. 

“We want to make progress,” the official said. “We’re not laying out a specific path.”

The official said the president leaving out any mention of the expired enhanced tax credits for people who purchase their health insurance from the Affordable Care Act marketplace was not intended to cut off ongoing bipartisan talks in the Senate. 

“This does not specifically address those bipartisan congressional negotiations that are going on,” the official said. “It does say that we have a preference that money goes to people, as opposed to insurance companies.”

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. 

“We believe by codifying it, we’ll make sure that the drug companies stay engaged for future administrations,” Oz said. “We also believe that by doing it correctly, we’ll not overreach and create challenges to life-saving drugs being continually evolved and developed in the United States.”

The Trump administration, he said, wants Congress to give the Food and Drug Administration more leeway to convert prescription medications to over-the-counter availability, possibly increasing competition and decreasing prices. 

Oz said the price transparency portion of the request would help Americans to have more information about how long it takes to get routine appointments and whether health insurance companies are able to keep their rates down by frequently denying claims.

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”

Sen. Bill Cassidy, R-La., answers questions from reporters after chairing a hearing of the Senate Health, Education, Labor and Pensions Committee on Sept. 17, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. Senate Republicans announced Tuesday they will hold a vote on their own health care proposal later this week to counter a Democratic bill that would extend enhanced tax credits for Affordable Care Act marketplace plans for three more years.

The 32-page GOP bill would not address the expiring ACA marketplace tax credits but would send payments to certain Americans through Health Savings Accounts to cover some of the cost of health care. 

Neither measure has the 60 votes needed to advance under that chamber’s rules. That would leave the ACA marketplace subsidies to expire at the end of the year and dramatically spike the cost of health insurance for the millions of people enrolled in those plans. 

Senate Majority Leader John Thune, R-S.D., said Democrats’ bill to simply extend the enhanced ACA marketplace tax credits to offset the costs Americans pay for that insurance was unacceptable. 

“The way that the program is structured, the money goes straight to the insurance companies,” Thune said. “And the way that we think this ought to work is you ought to come up with a way in which you can deliver the benefit to the patients and not to the insurance companies.”

Thune said the Democratic bill lacks an income cap for ACA marketplace tax credits and allows $0 premiums for health insurance plans — guaranteeing the measure will fail.

Senate Democratic Leader Chuck Schumer, of New York, called the GOP proposal a “nonstarter” that would lead to “junk insurance.” He said the only way to avoid a dramatic increase in health insurance costs next year is to extend the enhanced ACA tax credits. 

“Their phony proposal is dead on arrival,” Schumer said. “The bill not only fails to extend the tax credits, it increases costs, adds tons of new abortion restrictions for women, expands junk fees and permanently funds cost-sharing reductions.”

Multiple plans

Senate Republicans have debated for weeks whether to hold a vote on a GOP plan to show the party has something to offer toward reducing health care costs. Thune promised Democrats a vote on a health care bill of their choosing in exchange for votes to end the government shutdown. 

Schumer announced last week that Democrats would hold the vote on a three-year extension of the enhanced ACA tax credits as they exist now. 

Several GOP senators, including Maine’s Susan Collins and Ohio’s Bernie Moreno, have released plans that would include an extension of the expiring tax credits while beginning to transition away from those subsidies. 

But Republican leaders ultimately decided to hold a vote on a proposal released earlier this week by Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., and Finance Committee Chairman Mike Crapo, R-Idaho. 

The Cassidy-Crapo legislation would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Proposal modeled on Trump comments

Cassidy and Crapo outlined how their proposal would work during afternoon floor speeches, where they also aired their grievances with how the Affordable Care Act has affected Americans’ health care costs. 

Crapo rebuked Democrats for establishing the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to sunset at the end of this year. 

“The pattern has become clear: Democrats respond to rising premiums by throwing taxpayer dollars at the problem,” Crapo said. “Their supposedly short-term fixes only drive premiums higher and make the problem harder to solve. Leaving us with apparently no choice other than to do the same thing again and again and again.”

The GOP plan, he said, was modeled off President Donald Trump’s request to send funding directly to Americans to spend on their health care. 

“Families can use that money to cover costs not handled by their insurance policy without having to wait for insurance companies to approve their treatment decisions,” Crapo said. “Because families want the best value for their money, they will seek out the most appropriate treatment. Over time this will result in lower health care costs as providers compete for patients.”

Cassidy said the bill would not subsidize health insurance premiums but would help some Americans pay for doctor exams, dentist visits, glasses and prescriptions. 

Once eligible ACA marketplace enrollees receive that funding in their Health Savings Accounts, he said, they will shop around for better prices, including on x-rays, which are often used to determine if someone has broken a bone. 

“She’s going to say, ‘Wait a second, the x-ray is $150 here and $500 there. I’m going to where it’s cheaper, not more expensive,’” Cassidy said, giving an example. “And I can tell you when that begins to happen, the people who are more expensive begin to lower their price.”