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.

Senate Majority Leader John Thune, R-S.D., center, joined by Senate Majority Whip John Barrasso, R-Wyo., left, and Sen. James Lankford, R-Okla., speaks to reporters following a Senate Republican policy luncheon at the U.S. Capitol on Dec. 9, 2025 in Washington, D.C.  (Photo by Heather Diehl/Getty Images)

WASHINGTON — The U.S. Senate in long-anticipated votes failed to advance legislation Thursday that would have addressed the rising cost of health insurance, leaving lawmakers deadlocked on how to curb a surge in premiums expected next year. 

Senators voted 51-48 on a Republican bill co-sponsored by Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027. 

They then voted 51-48 on a measure from Democrats that would have extended enhanced tax credits for people who purchase their health insurance from the Affordable Care Act Marketplace for three years. A group of Senate Democrats in November agreed to end a government shutdown of historic length in exchange for a commitment by Republicans to hold a vote on extending the enhanced subsidies.

Republican Sens. Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska voted for the Democrats’ bill. Sen. Rand Paul, R-Ky., voted against both bills. 

Neither bill received the 60 votes needed to advance under the Senate’s legislative filibuster rule. 

Senate Majority Leader John Thune, R-S.D., criticized the ACA marketplace and the subsidies for leading to large increases in the costs of health insurance. 

“Under Democrats’ plan insurance premiums will continue to spiral, American taxpayers will find themselves on the hook for ever-increasing subsidy payments,” Thune said. “And don’t think that all those payments are going to go to vulnerable Americans.”

Thune argued Democrats’ bill was only an extension of the “status quo” of a “failed, flawed, fraud program that is increasing costs at three times the rate of inflation. 

Thune said the Republican bill from Cassidy and Crapo would “help individuals to meet their out-of-pocket costs and for many individuals who don’t use their insurance or who barely use it, it would allow them to save for health care expenses down the road.”

Schumer calls GOP plan ‘mean and cruel’

Senate Minority Leader Chuck Schumer, D-N.Y., said the three-year extension bill was the only option to avoid a spike in costs for people enrolled in ACA marketplace plans. 

“By my last count, Republicans are now at nine different health care proposals and counting. And none of them give the American people the one thing they most want — a clean, simple extension of these health care tax credits,” Schumer said. “But our bill does extend these credits cleanly and simply and it’s time for Republicans to join us.”

Schumer referred to the Cassidy-Crapo proposals as “stingy” as well as “mean and cruel.”

“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said. “And even to qualify for that check, listen to how bad this is, Americans would be forced onto bare-bones bronze plans with sky-high deductibles; $7,000 or $10,000 for an individual, tens of thousands for a couple.”

After the votes failed, Schumer outlined some of the guardrails Democrats would put in place regarding negotiations with GOP colleagues.

“They want to talk about health care in general and how to improve it — we’re always open to that, but we do not want what they want — favoring the insurance companies, favoring the drug companies, favoring the special interests and turning their back on the American people,” he said. 

Health Savings Accounts in GOP plan

The Cassidy-Crapo bill 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. 

Members of Congress have introduced several other health care proposals, including two bipartisan bills in the House that would extend the enhanced ACA marketplace tax credits for at least another year with some modifications. 

Speaker Mike Johnson, R-La., has been reluctant to bring either bipartisan bill up for a floor vote, though he may not have the option if a discharge petition filed earlier this week garners the 218 signatures needed. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

But Johnson said Wednesday that he will put a package of bills on the House floor next week that he believes “​​will actually reduce premiums for 100% of Americans who are on health insurance.” Details of those bills have not been disclosed.

Thune told reporters that if “somebody is successful in getting a discharge petition and a bill out of the House, obviously we’ll take a look at it. But at the moment, you know, we’re focused on the action here in the Senate, which is the side-by-side vote we’re going to have later today.” 

Alaska’s Murkowski said lawmakers can find a compromise on health care by next week “if we believe it is possible.”

Political costs

The issue of affordability and rising health care costs is likely to be central to the November midterm elections, where Democrats hope to flip the House from red to blue and gain additional seats in the Senate. 

The Democratic National Committee isn’t waiting to begin those campaigns, placing digital ads in the hometown newspapers of several Republicans up for reelection next year, including Maine’s Collins and Ohio’s Jon Husted. 

“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”

White House press secretary Karoline Leavitt blasted Senate Democrats’ proposal during Thursday’s press briefing, calling it a “political show vote” meant to provide cover for Democrats, whom she blamed for creating the problem. 

Trump and Republicans would “unveil creative ideas and solutions to the health care crisis that was created by Democrats,” she said. “Chuck Schumer is not sincerely interested in lowering health care costs for the American people. He’s putting this vote on the floor knowing that it will fail so he can have another talking point that he can throw around without any real plan or action.”

Shauneen Miranda and Jacob Fischler contributed to this report.