White House Releases "The Great Healthcare Plan" Amid Tense Affordable Healthcare Act Negotiations
On January 15, 2026, the White House rolled out President Donald Trump’s “Great Healthcare Plan,” framing it as a cost-cutting package that would lower drug prices, reduce insurance premiums, and force more transparency from insurers and providers.
The plan is presented as a framework, the administration is explicitly asking Congress to “act,” and major operational details (eligibility, benefit design, administration, guardrails) are not fully spelled out in the materials released so far.
The plan is broken into six main pillars in the White House document.
“Most-Favored-Nation” drug pricing (international reference pricing)
The White House says the plan would codify “Most-Favored-Nation” deals so Americans pay drug prices comparable to the lowest prices paid in other countries. The one-page fact sheet frames this as building on prior Trump administration actions and recent negotiations, including “grandfathering” voluntary deals negotiated with HHS/CMS.
Expand over-the-counter access for certain medicines
The framework calls for making more “verified safe” drugs available over the counter, arguing that easier OTC access could reduce costs and lessen the need for some doctor visits.
Redirect subsidy dollars “directly to the people”
The most politically and operationally significant idea is a shift away from paying certain subsidies to insurers and toward direct payments to eligible Americans to buy coverage via health savings accounts (HSAs).
Fund ACA cost-sharing reductions (CSRs)
The fact sheet says the plan would fund a cost-sharing reduction program, claiming it would save taxpayers and reduce premiums for common ACA marketplace plans by 10%, with a cited taxpayer savings figure of at least $36 billion.
Cut “kickbacks” and increase insurer accountability
The plan targets intermediaries by calling to end certain “kickbacks,” including those involving pharmacy benefit managers (PBMs) and “brokerage middlemen,” and it proposes new insurer disclosures about how premium dollars are used.
A transparency push: “plain-English insurance” + “post prices on the wall”
The White House materials emphasize “sunlight” and shopping power: insurers would be required to publish rate/coverage comparisons in plain language, plus metrics like overhead vs. claims, claim denial rates, and wait times. Providers and insurers accepting Medicare or Medicaid would face requirements to publicly post prices and fees to reduce surprise bills.
Despite outlining six pillars, the document is surprisingly light on the details of how this framework would actually function in practice. Major questions remain unanswered, including how the direct payment concept would work, the massive legislative hurdles that would need to be cleared for implementation, and how replacing or redirecting subsidies would ultimately affect consumers.
Not surprisingly, the rollout of this plan also comes amid ongoing fights over Affordable Care Act negotiations that have increasingly strained Congress. Just yesterday, Politico reported that bipartisan Senate health care talks are “on thin ice.” Senate Majority Leader John Thune said Thursday, when asked about the status of negotiations, “It doesn’t look like they’re close.” Republicans involved in the talks disagree on which policy issue has left discussions stalled, and some have begun blaming Democrats for failing to come to the table on a compromise, an ominous sign for a deal that requires buy-in from both sides of the aisle.
Ultimately, the Great Healthcare Plan is best understood as a cost- and transparency-first framework, but its implementation and progress will depend on Congress...which, at this moment, is rarely a safe bet.