Brickbats but also bouquets for Trump’s Great Healthcare Plan

The healthcare plan recently proposed by the Trump administration has some fans, but it has also been greeted with skepticism about the potential benefits of putting money directly in the hands of consumers. The “Great Healthcare Plan,” which had few details when it was unveiled on Jan. 15, would reroute billions of dollars in subsidies used to help Americans purchase health insurance, sending the money directly to individuals. The money would go into something like a health savings account (HSA), which would be available to buy health insurance.

“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 healthcare,” President Donald Trump said in the video announcing the plan.

Sachin Jain, M.D., MBA, president and CEO of the SCAN Group and SCAN Health Plan, is skeptical. “I think there has been a consumerism fantasy in and around the health policy universe for close to three decades now.” Although some people think putting money directly in the hands of consumers means they will “make rational decisions,” Jain says he believes that many people would instead “avoid or delay seeking care.”

Stephen Crystal, Ph.D., M.A., a professor at the Institute for Health, Health Care Policy and Aging Research at Rutgers University, also has his doubts. Although the theory is “people will be more motivated consumers and seek out less expensive healthcare to drive down the cost of healthcare, it doesn’t actually work,” he says. The effect is opposite, Crystal contends. “Individuals can’t negotiate on price with healthcare providers nearly as effectively as health insurance plans can.”

But Ge Bai, Ph.D., is among those who see the Trump plan as a way of unleashing market forces and ultimately making healthcare more affordable. “This is the only way Americans are actually consumers of healthcare, rather than passive takers of healthcare,” says Bai, a professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.

Once people meet their deductible, they don’t really care about the cost of healthcare, Bai says. Giving them the money directly “is the only way for people to have skin in the game.” As they control where their healthcare dollars go, it will result in a “downward pressure on prices,” Bai predicts.

Jain counters that “insurance is complicated. There’s a whole alphabet soup of language most Americans don’t understand. If you feel overwhelmed, you just don’t make decisions.” Instead, the focus should be on “having low barriers to access and keeping people healthy,” Jain said.

Dearth of detail

Although underlying concepts are fairly clear and familiar to those in healthcare policy circles, the particulars will matter, and there were few of them in the announcement of the Great Healthcare Plan made by President Donald Trump and the accompanying written material. There was no information on how much money will go to individuals or about who exactly will be eligible to get the federal money. In his comments on the plan, Trump said that by giving consumers money directly, “the big insurance companies lose and the people of our country win.” The president urged Congress to “pass this framework into law without delay.” Trump mentioned his plan in his State of the Union address on Feb. 24 but only briefly during an address that lasted almost two hours.

CMS Administrator Mehmet Oz also talked about the proposal being a “framework” to help Congress write and pass legislation, according to an Associated Press report. But it was unclear whether anyone in Congress was working on such legislation. Drew Altman, president and CEO of KFF, said in a statement, “We have been trying to analyze the Trump health ‘plan,’ but I worry that unless Congress puts something real together, we are analyzing air.”

The Paragon Health Institute, a conservative health policy think tank, was strongly supportive of Trump’s plan in a statement posted on its website. “The president takes a firm line against sending additional taxpayer money to health insurance companies,” it said. “Empowering patients rather than insurers is vital to reorient the system to meet patient needs instead of boosting insurer profits and the power of the medical-industrial complex.”

“Paragon’s HSA option remains the best-developed policy for efficiently redirecting subsidies from insurers to patients, and we encourage its integration,” it said.

“Overall, the plan offers practical, pro-patient reforms that will deliver meaningful relief and move the nation in the right direction to positively transform our ailing healthcare system. We look forward to collaborating with the administration and Congress to refine and advance these reforms to help both American patients and American taxpayers,” Paragon added. The institute did not respond to a request for comment.

Katherine Hempstead, Ph.D., has a very different take. “It’s not really a serious idea. It’s neither great nor a plan,” says the senior policy officer at the Robert Wood Johnson Foundation.

If the proposal gained traction, it could push more people who buy their health insurance under the Affordable Care Act (ACA) to switch from silver to bronze plans that have lower premiums, Hempstead predicts. Bronze plans tend to have much higher out-of-pocket costs, placing additional financial strain on people who use healthcare services. “It’s not some kind of anticorporate revolutionary act to buy a bronze versus silver plan,” Hempstead said. Instead, it could leave consumers “trading off financial protection for a small amount of cash.”

The HSA-like accounts are a standout feature of what Trump has proposed. But the announcement of the Great Healthcare Plan also mentioned the administration’s most favored nation drug pricing policies, lowering insurance premiums and price transparency requirements for insurers and providers. Many of the key elements would require Congress to pass legislation, a political shot. Some of other elements could be accomplished through rulemaking, but the rules could be tied up by litigation.

ACA under pressure

Although no one is sure how much money the administration might want to send to consumers, Republican leaders in Congress previously floated a plan that would have put $1,000 in the accounts of those between the ages of 18 and 49 who purchase health insurance on ACA exchanges and $1,500 for those between the ages of 50 and 64.

The ACA has been under the intense focus of both the public and policymakers as larger premium tax credits, which were put in place because of the COVID-19 public health emergency, expired at the end of 2025. As a result, premiums more than doubled for many Americans, and ACA enrollment has slid. With the enhanced premium tax credits, enrollment in ACA plans soared from approximately 12 million in 2021 to more than 24 million in 2025. So far this year, enrollment has fallen by more than 1 million, and more individuals are expected to drop coverage when they see their higher health insurance bills. The House voted in December to extend the enhanced subsidies for three years, but the Senate has not taken up the measure.

“People are incredibly frustrated and hugely impacted by the expiration of subsidies,” Crystal says.

Healthier people, facing higher premiums, might elect to go without health insurance coverage, leaving only those who are sicker in the ACA market, Crystal says. “It’s moving in the direction of fragmenting insurance markets versus creating sustainable risk pools in the insurance market.”

If the Great Healthcare Plan wants to send money to those with ACA coverage, it would be “harder to achieve politically,” says Edmund Haislmaier, a senior research fellow at the Heritage Foundation. “You need Democratic buy-in.” If people consider themselves healthy and think they don’t need insurance, “it’s hard to sell them to get insurance,” Haislmaier said. But sending them money directly “might have some benefit and draw more people into the system.” In 2024, nearly 10% of the U.S. population was uninsured, according to KFF. Government data from 2019 found the uninsured rate was highest for younger adults between the ages of 19 and 34, topping 15%.

Haislmaier thinks it would be easier to offer the money to businesses that could set up individual coverage health reimbursement arrangements, allowing them to provide tax-free reimbursements for workers for health insurance premiums and other qualified medical expenses. Offering small businesses such an option “gives them the ability to be more competitive with salary and benefits without the hassle of trying to find a (health) plan that suits everybody,” Haislmaier says.

Critics of the notion of sending money to consumers do see an upside to the current situation. “Healthcare is back on the national agenda,” Jain says. “The whole sector is broken.”

Hempstead agrees. “We’re at a bit of an inflection point. Behind all this is a growing sense that this version of managed care does not work. I do think there is a consensus growing for systematic change.

“People question the value added [that] insurance companies really are providing,” she adds. “Everyone hates them. They’re a convenient villain.”