What we know about Trump’s ‘Great Health Care Plan’

By Tami Luhby, CNN

(CNN) — Seeking to show Americans that he’s concerned about affordability, President Donald Trump on Thursday released his long-awaited plan to tackle the high cost of health care.

Light on details, the proposal is largely a broad framework of the president’s health care priorities, including reducing drug prices, lowering health insurance premiums and increasing price transparency. It punts the hard work of coming up with specific legislation to Congress, though the White House said it will work with lawmakers.

What the plan does not recommend is extending the Affordable Care Act’s enhanced premium subsidies, which expired at the end of last year and sent premiums soaring for more than 20 million Americans for 2026. The Senate is currently wrestling with whether to renew the subsidies.

It also does not make changes to Medicare or Medicaid, which cover nearly 150 million people.

Trump’s promise to lower health care costs comes as premiums are jumping in Medicare and employer plans, in addition to the Obamacare exchanges. The president has also said he will meet with insurers soon to discuss lowering premiums, much as he has pressured drugmakers to reduce prices.

“You can have great health care at a much lower price,” President Donald Trump said at a White House event on rural health care on Friday. “This is the biggest thing to ever happen to health care in our country.”

Here’s what’s in Trump’s health care plan:

Drug prices

Trump is calling on Congress to codify the “Most Favored Nation” deals he signed with 16 drugmakers in recent months. Under the voluntary agreements, manufacturers will provide their products to Medicaid and launch new medicines in the US at “Most Favored Nation” prices, which are the lowest prices available in peer countries. (Other nations’ governments often negotiate or set prices they will pay for medicines.)

Also, the drugmakers have agreed to sell certain medications at a discount to patients willing to pay cash through TrumpRx, which is expected to launch soon. And they will beef up their investments in US manufacturing in exchange for three-year reprieves from tariffs on pharmaceutical imports.

While these agreements might reduce patients’ prices for certain medicines, experts have questioned how much it will move the needle on drug costs for most Americans.

The framework also aims to allow more prescription drugs to be sold over the counter. These could include gastric ulcer and higher-dose nonsteroidal medications, according to Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services.

Insurance premiums

Following Trump’s repeated demands, the plan calls for sending federal subsidy payments directly to consumers, instead of insurers, to allow them to buy health insurance on their own.

Healthier people could potentially find less expensive, less comprehensive policies outside of the Affordable Care Act marketplace. But if they leave Obamacare, it could greatly raise the cost of coverage for the sicker enrollees who remain, potentially cratering the exchanges.

The plan also asks Congress to restore federal funding for a second set of Obamacare subsidies that help lower-income enrollees with out-of-pocket costs. Trump eliminated this support in his first term, which led insurers to raise premiums on silver-level plans on the exchange. That, in turn, led to larger premium subsidies. (There are four main metal tiers in Obamacare, ranging from bronze to platinum.)

Funding the cost-sharing subsidies would save taxpayers $36 billion over a decade and reduce premiums for certain silver plans, according to the Congressional Budget Office. But many enrollees would wind up paying more for other plans on the exchanges.

Trump’s plan would also “end the kickbacks” paid by pharmacy benefit managers, known as PBMs, to large brokers that lead to higher health insurance costs. Congress has been working on reforming the opaque PBM industry — which serves as middleman between pharmaceutical companies and insurers — for years, but has yet to approve legislation. PBMs say they are an essential player in lowering drug prices for their clients and place the blame on pharmaceutical manufacturers for keeping costs high.

Insurance companies

Insurers would have to publish their rate and coverage comparisons in plain English, and the share of their revenues paid out to claims versus overhead costs and profits on their websites, under the framework.

Under the Affordable Care Act, insurers are required to spend 80% to 85% of premiums on policyholders’ medical care. Known as the medical loss ratio, this data is already publicly available.

Also, insurers would have to publish the share of claims they reject and the average wait times for decisions. Denials of prior authorization requests is a hot-button topic for many patients and providers, and insurers have already promised the Trump administration that they would improve.

It’s unclear what the wait times provision entails since insurers don’t control providers’ schedules. CNN has reached out to the White House for more details.

Price transparency

Any health care provider or insurer that accepts Medicare or Medicaid would have to post their prices and fees in their place of business, according to the plan.

The first Trump administration required hospitals and insurers to post certain prices, but experts say that most patients don’t shop for care and the data is difficult to navigate.

Also, some hospitals have used the pricing information to try to negotiate higher payment rates from insurers and employers, even as they push to lower how much they pay providers.

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