Is Donald Trump's 'Great Healthcare Plan' truly great? The answer might shock you: it's barely a plan at all. In fact, calling it a 'plan' is like calling a mirage an oasis – promising much, delivering nothing.
On Thursday, Donald Trump unveiled what he’s touting as “The Great Healthcare Plan.” But here’s the harsh reality: it lacks the fundamental elements of a genuine plan. A real healthcare plan isn't just a catchy title; it demands substance, detailed figures, and a team of experts ready to explain and defend every aspect. It should be the result of extensive behind-the-scenes work, marking the beginning of a serious, sustained effort to get legislation through Congress. Ask yourself, does this so-called plan meet those criteria? Sadly, the White House’s recent offering falls drastically short.
Consider the evidence. The online summary clocks in at a mere 350 words, squeezed onto a single printed page. The “extended fact sheet” stretches to a paltry 825 words. To put that in perspective, Trump sometimes writes more than that in a single day on Truth Social. And this is the part most people miss: it's not like those 825 words are packed with detailed policy substance.
About a third of the document summarizes some rather modest – or, as Trump would have it, “historic” – executive actions he’s already taken. The remainder is simply a list of ideas that Trump or Republicans in Congress have previously endorsed. There's virtually no specific guidance on how to transform these ideas into actual, workable legislation. It's like having a recipe without measurements or instructions – you might have the ingredients, but you're unlikely to bake a cake.
It’s difficult to gauge the actual effort invested in this proposal. Perhaps dedicated individuals at the Office of Management and Budget or the Domestic Policy Council burned the midnight oil to craft the document's language. But the reaction on Capitol Hill – a resounding collective shrug – speaks volumes. It suggests that the White House didn’t dedicate much time to coordinating with the very people whose input and support would be essential to passing any healthcare law. This raises a critical question: can a plan succeed without buy-in from key players?
"It doesn’t appear to have done anything positive,” Debbie Curtis, a principal at the health care lobbying and consulting firm McDermott+, told me. “If Congress wants to tackle health care, they have to think through what they want to do. This doesn’t help them do that.”
None of this is particularly surprising. Trump has been promising to unveil “great” healthcare plans throughout his two presidential terms, dating back to his initial campaign and his crusade to repeal the Affordable Care Act (ACA), also known as Obamacare. “I am going to take care of everybody,” Trump boasted in a 2015 CBS News interview. “Everybody’s going to be taken care of much better than they’re taken care of now.”
But you can count on one hand the number of times Trump has actually produced a written proposal. And even those documents were more akin to "concepts of a plan" – in essence, press releases filled with talking points. That’s a fair description of what his administration released on Thursday.
Honestly, it's become a bit of a running joke among those who closely follow health policy. And yet, on Thursday, many of us found ourselves on a White House briefing call, wondering if this time might be different. Not because Trump has shown any increased seriousness about policymaking, but because the current political climate seemed to demand some kind of action.
Trump’s poll numbers are currently struggling, with voters citing the high cost of living as a major concern. That includes the price of healthcare, which recently increased for over 20 million Americans who rely on the ACA. The reason for this increase is the expiration of a temporary boost in the program’s subsidies, which Democrats have been advocating to renew. This sets the stage for a political showdown, but here's where it gets controversial...
Republicans have largely refused to support any expansion of healthcare, particularly if it’s tied to “Obamacare.” GOP leaders even rejected considering the subsidy expansion when Democrats briefly shut down the government over it, later declaring victory when a Senate vote on the extension failed in December.
However, things haven’t gone smoothly for the Republicans since then. Across the country, GOP lawmakers are hearing from constituents whose premiums have skyrocketed – sometimes by hundreds or thousands of dollars annually, and in extreme cases, by many thousands. These individuals are either absorbing the increase, switching to cheaper plans with higher out-of-pocket costs, or dropping coverage altogether.
This pressure led to the passage of legislation extending the subsidies in the House, with seventeen Republicans breaking ranks to vote with the Democrats. While the Senate rejected that proposal, a bipartisan group is working to find a compromise that can pass both houses (and then return to the House for final approval).
Negotiations have since stalled, making Thursday’s plan the latest opportunity for Trump to clearly state his preferences. Initially, it seemed like he might do just that, endorsing two key ideas that Republicans have been discussing in the subsidy debate.
One idea, which has received considerable attention, involves diverting some of the extra subsidy money into tax-advantaged spending accounts for healthcare. Republicans favor this approach, arguing that it empowers individuals to control their spending, thereby fostering competition and driving down prices. Trump even echoed their rallying cry, stating that it would “send the money directly to the American people” rather than to large insurance companies.
The other idea Trump endorsed is providing funding for “cost-sharing reductions,” a complex mechanism within the ACA that lowers out-of-pocket costs for lower-income buyers. The fact sheet promotes this as both lowering premiums for standard ACA plans and saving the federal government $36 billion. But is it really a win-win?
Making healthcare cheaper while saving money sounds too good to be true. And in this case, it is. Due to the law’s complex formula for calculating assistance, “funding” this feature would paradoxically make insurance more expensive for millions. In fact, the Congressional Budget Office predicts that it would lead several hundred thousand people to drop coverage altogether.
The effects of shifting subsidy money into health savings accounts would depend on the specifics of implementation. However, the version favored by most Republicans – championed by Senator Bill Cassidy of Louisiana – comes with a significant catch: eligibility for the extra money would require enrollment in a plan with extremely high copays and deductibles. The math would work out poorly for many, particularly those with significant medical needs, as the extra money wouldn’t offset the higher out-of-pocket expenses.
Democrats view this idea as toxic. So is funding the cost-sharing reductions. A serious effort to include them in legislation would diminish the already slim chances of a compromise. But here's a question to ponder...
But – and this was arguably the most peculiar aspect of Trump’s announcement – the endorsement of these ideas was noticeably lukewarm. During a briefing call with reporters on Thursday, a White House official, speaking anonymously, stated that Trump’s proposal “does not specifically address those bipartisan congressional negotiations that are going on.”
It’s possible that Trump and his advisors made a conscious, strategic decision not to foreclose any potential outcomes from the bipartisan talks on Capitol Hill. But staying out of the process won’t facilitate a deal, either. Securing sixty votes in the Senate would almost certainly require pressuring Republicans who are hesitant to support any extension of the subsidies – either due to the increased government spending or the demand from some conservatives (unacceptable to most Democrats) to roll back abortion coverage.
And Trump, who earlier in January made comments suggesting he was open to pushing Republicans on that front, has remained silent since.
The White House claims that this ambivalence regarding the fate of the ACA subsidies is a deliberate attempt to shift the conversation beyond the debate over the law itself.
In fact, when Washington Post White House correspondent Dan Diamond tweeted that Trump’s plan was a “grab bag” of familiar proposals that “feel far short” of the ACA replacement he’s long promised, a White House spokesperson responded that Trump’s plan was much broader – designed to lower costs for all Americans, not just the 7 percent who get coverage through the ACA.
“This is comprehensive, commonsense reform that some Fake News clowns are struggling to comprehend,” wrote White House Deputy Press Secretary Kush Desai.
Ambition was also a central theme of the White House briefing call, led by Mehmet Oz (Dr. Oz), the celebrity physician and former Senate candidate now serving in the Trump administration. “The real question,” said Oz, who now oversees Medicare, Medicaid, and the ACA, “is how do we get past lazy lawmaking and actually start to address the underlying problems – not just throw more taxpayer money at issues, but get to the root causes of why the system right now is not really great.”
He’s right about the importance of addressing those root causes. The United States spends more on healthcare than any other developed nation, and spending has been rising more rapidly in the past few years. This isn't due to the ACA, as Trump and Republicans often claim, but to underlying factors such as hospital monopolies and the high cost of new drugs.
One approach would be to use government power to lower drug prices, an issue Trump has consistently discussed. He could find common ground with Democrats in this area. Trump's preferred method is to link U.S. prices to the lower prices other countries achieve through direct negotiation with manufacturers, a concept known as “international reference pricing.”
Trump calls it giving the United States “Most Favored Nation” status on drug prices – which is undeniably good marketing. He has personally negotiated agreements with drug manufacturers that he claims will lower prices. But it’s uncertain whether these deals will produce real savings, or what he promised in return. Whatever their short-term impact, they are voluntary. A significant, long-term effect on drug prices would require legislation.
Here again, the obstacle is congressional Republicans, who argue that government interference would distort markets and stifle innovation – and who are generally close to the pharmaceutical industry. If Trump were serious about passing “Most Favored Nation” legislation, as the document states, he could pressure wary Republicans as he did when securing votes for Medicaid cuts in his “One Big Beautiful Bill” last summer.
But there are no signs that Trump is making that effort. And the history isn't encouraging. Trump had a chance to pass similar legislation during his first term, but he failed to act.
This is yet another reason to believe that Trump is more interested in generating favorable publicity than in passing legislation to make healthcare more affordable. He seemed to struggle even with that task during a recent healthcare event.
The event was a roundtable that included several Republican lawmakers facing tough re-election battles, partly due to the ACA price hikes. About fifty minutes in, as they were speaking, Trump began tapping his fingers and looking around the room. “We are way behind schedule and I have a couple of meetings that are very important,” he announced between speakers, later whispering something that sounded like “We gotta finish this.”
Eventually, the meeting ended, and the lawmakers left, heading back to districts and states where they'll have to face their constituents. And Trump? He also left Washington, spending the weekend at Mar-a-Lago.
So, what do you think? Is Trump's healthcare plan a genuine effort to address rising costs, or simply a political maneuver? Share your thoughts in the comments below. Do you agree with the assessment that it lacks substance and detail? Are there any aspects of the plan that you find promising or concerning? Let's discuss!
