President releases outline of healthcare plan

President Donald Trump released a fact sheet outlining a package of healthcare changes called the Great Healthcare Plan. The fact sheet includes proposals to address Affordable Care Act (ACA) premium assistance, prescription drug prices and healthcare transparency.

Specific proposals include the following:

• Send premium subsidies directly to enrollees so they can “buy the health insurance of their choice.” The fact sheet does not specifically mention health savings accounts (HSAs), though legislation introduced in response to President Trump’s previous call to provide assistance directly to enrollees would use HSA-type accounts.
• Fund ACA cost-sharing reductions, which reduce out-of-pocket costs for eligible individuals enrolled in ACA silver plans.
• Codify most-favored nation prescription drug pricing. The administration has negotiated several most-favored nation deals since signing an executive order in May 2025.
• Allow more drugs to be available over the counter if they are “verified safe.”
• Reform pharmacy benefit manager (PBM) practices. The proposal would “end the kickbacks paid by” PBMs.
• Require insurers to publish:
  • Plain language rate and coverage comparisons
  • Percentage of revenues used for claims rather than overhead costs or profits
  • Percentage of claims they reject and average wait times for routine visits
• Require providers and insurers that accept Medicare and Medicaid to prominently post pricing and fees.

Many proposals in the Great Healthcare Plan require legislative action. It is not clear whether Congress will act on the proposals this year. Employer plan sponsors and their advisors should continue to monitor activity on this proposal.