In record-long State of the Union, Trump devotes less than five minutes to healthcare

In an hour and 48-minute speech that set the record for length for the State of the Union address, President Donald Trump spent less than five minutes on healthcare issues.

At approximately 35 minutes into the speech, Trump launched into attack of the Affordable Care Act (ACA), saying that it had made insurance companies rich and had benefited the companies, not people. The government, said Trump, had given insurers “hundreds and hundreds of billions of dollars a year as their stock prices soared 1,000, 1,200; 1,400 and even 1,700%, like nothing else.” Trump said that is why he proposed his Great Healthcare Plan, which was unveiled in January 2026. “I want to stop all payments to big insurance companies and instead give that money directly to the people so they can buy their own health care, which will be better health care at a much lower cost.”

ACA premium subsidies are not payments to insurers, as Trump is suggesting, but subsidize health premiums so the cost to the individual is lower. Enhanced ACA premiums that were implemented during the COVID-19 public health emergency and then extended before expiring at the end of 2025 after congressional Republicans and Democrats couldn’t come to an agreement about keeping them going.

Sens. Rick Scott, a Republican from Florida, and Bill Cassidy, a Republican from Louisiana, have each introduced legislation that differs in some important details but would send federal government funds into accounts similar to the health savings accounts, paired with high-deductible coverage, that many employees have through employer-provided health insurance. The money in the accounts that Scott and Cassidy have proposed — and that are central to Trump’s Great Healthcare Plan — could be used to pay for health insurance premiums or cover out-of-pocket health insurance.

In the short segment of the speech about healthcare, Trump also said his Great Healthcare Plan would require “maximum price transparency,” and he heaped blame on Democrats for ending the transparency he accomplished in his first term with “full knowledge that they were doing a very bad thing for the people.” Hospital price transparency rules took effect in January 2021 after an unsuccessful legal challenge by the American Hospital Association and health insurance transparency rules went into effect in July 2022. There have been issues with the completeness and accuracy of the machine-readable files that hospitals and health plans have made available and lack of meaningful enforcement.

In February 2025, the second month of his second term, Trump issued an executive order that aims to strengthen healthcare price transparency requirements, and price transparency was mentioned in the written materials about the Great Healthcare Plan that the White House issued in January.

Trump took credit for lowering drug prices during his address last night. “Other presidents tried to do it, but they never could. They tried. Most didn't try, actually, but they tried. They said they tried. They couldn't do it. They didn't even come close. They were all talk and no action. But I got it done,” he said

Trump said that under his most favored nation drug pricing agreements, “Americans who for decades paid by far the highest prices of any nation anywhere in the world for prescription drugs will now pay the lowest price anywhere in the world for drugs —-anywhere, the lowest price.” Trump said the result is price differences of “300, 400, 500, 600% and more” and that the drugs are available at TrumpRx, the website that has aggregated direct-to-consumer price deals that pharmaceutical companies have negotiated with the administration.

Currently, there are 43 drugs listed on the TrumpRx website, so a relatively small fraction of the drugs on the market. TrumpRx has no purchasing functionality itself but provides links to websites set up by pharmaceutical companies to sell drugs in the direct-to-consumer market are marked down from list prices. But insurers and other payers also pay much less than list prices after various discounts and rebates are factored in. Experts also have questioned whether the discounted prices listed on TrumpRx are the lowest among developed countries, and purchasers in low-income countries, often government health departments, often pay much lower prices than those paid in countries with more advanced economies.

Trump singled out Catherine Rayner as the first customer of TrumpRx during his address. According to Trump, Rayner paid less than $500 for invitro fertilization (IVF) drugs via TrumpRx for drugs that were costing her $4,000, a savings of $3,500.

The only fertility drugs currently listed on TrumpRx are EMD Serono’s three fertility drugs: Gonal-F (follitropin alfa), Cetrotide (cetrorelix) and Ovidrel (choriogonadotropin alfa). They have different purposes and women are prescribed all three as infertility treatments. The discounts listed for the three drugs on TrumpRx add up to $1,658.46.