President Trump Moots Direct Health Care Payment Plan

A more complete article on President Trump's direct health care payment plan in The Hill, today:

https://thehill.com/homenews/administration/5610525-trump-direct-healthcare-payments/

Trump says he would only approve direct health care payment legislation
By Ashleigh Fields - November 18, 2025

President Trump on Tuesday said amid rising health care premiums he would only consider approving legislation that provides a pathway for direct health care payments.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH,” Trump wrote in a statement on Truth Social.

“THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE! Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!! GET IT DONE, NOW,” he added.

Affordable Care Act (ACA) premium subsidies are set to expire at the end of the year, causing health care costs to skyrocket for Americans if a new solution isn’t reached before 2026.

Trump’s Tuesday post follows remarks he made over the weekend touting “personal talks with Democrats” in regards to the measure.

He noted that the people he’s spoken with “love” the plan.

“The insurance companies are making a fortune,” Trump told reporters on Sunday.

“Their stock is up over a thousand percent over a short period of time. They are taking in hundreds of billions of dollars, and they’re not really putting it back, certainly like they should.”

For years, Republicans have attempted to ditch ACA plans for a program that allows more cost negotiations and collective bargaining.

On Monday, Sen. Bill Cassidy (R-La.), who chairs the Senate Health, Education, Labor and Pensions Committee, shared a proposal similar to Trump’s suggesting that extra existing funds be redirected from insurance companies to consumers.

“As a conservative, I love it, but I think it’s got a lot of appeal to people who are left of center, too,” Cassidy said of the plan, according to the New York Post.

He said his idea remains in the works as he seeks an assessment from corresponding government agencies, but Cassidy shared a optimistic outlook that falls in line with the president’s view on the subject.

“Who would not want to spend 100 percent of the dollars on the patient choosing the health care she wants, as opposed to 100 percent going to insurance companies and the 80 percent being spent on health care … and that health care is what the insurance company decides that you need?” Cassidy told reporters.

Senate Republicans are thrashing out the details:

https://thehill.com/policy/healthcare/5611836-trump-republicans-aca-subsidies-health-care-plan/

What to know about GOP’s ObamaCare talks
By Nathaniel Weixel and Joseph Choi - November 19, 2025

Republicans are rushing to deliver an alternative to the Affordable Care Act’s (ACA) enhanced subsidies ahead of a self-imposed mid-December deadline.

President Trump wants to send ACA subsidy money directly to consumers, and Republicans are trying to find a way to make that happen.

Republicans spent weeks during the government shutdown refusing to negotiate with Democrats on health care and now are considering their own ideas to replace the subsidies, despite the political danger of letting them expire.

The ideas are vague, and many health experts warn a direct cash proposal could create a “death spiral” in the marketplace where healthy people would drop coverage and use the subsidy cash to pay their limited out-of-pocket costs, leaving sicker and expensive patients with sky-high premiums.

Here’s what to know about the push:

Trump complicates talks

Trump on Tuesday told Congress not to “waste” time on an extension of the enhanced subsidies, taking a harder line against them at a time when some lawmakers are looking for a bipartisan compromise.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE,” Trump wrote Tuesday on Truth Social.

Trump said people could “buy their own, much better, insurance” and doubled down on his idea to send money directly to consumers.

Over the weekend, Trump said he’d had “personal talks with some Democrats” about his direct health care payment plan.

“The insurance companies are making a fortune,” Trump told reporters in Florida. “Their stock is up over a thousand percent over a short period of time. They are taking in hundreds of billions of dollars, and they’re not really putting it back, certainly like they should.”

It’s not clear what Trump’s plan is. Giving people money to buy health insurance is how the Affordable Care Act exchanges work.

But he insisted, “This is the only way to have great Healthcare in America!!! GET IT DONE, NOW.”

Cassidy has a plan

Sen. Bill Cassidy (R-La.) unveiled a plan to use untaxed Health Savings Accounts (HSA) to help consumers pay out-of-pocket expenses.

Cassidy’s plan is not the official Republican position, and he hasn’t released legislation. But it aligns with Trump’s demand to end the enhanced subsidies and send money directly to consumers.

“I can say that if you look at the broad outlines of what I’m speaking of, it is clearly the broad outlines of what the president is speaking of,” Cassidy said. “If you’re going to get it done by 2026, then you got to accept that which you’ve got to work with. And so it kind of pushes everybody in the same direction.”

As chair of the Senate Health, Education, Labor and Pensions Committee, Cassidy is among a group of Republicans tasked with negotiating the future of the enhanced subsidies with Democrats ahead of a mid-December vote.

Cassidy said his proposal would allow people who purchase bronze plans on the ObamaCare exchanges to receive a prepaid Health Savings Account, funded in part by the lapsed enhanced subsidies.

Bronze plans have lower premiums but higher deductibles. They are the only ObamaCare plan eligible for HSAs; Trump’s tax bill changed the rules so that all bronze plans are eligible for HSAs starting Jan. 1.

HSAs can’t be used to pay for monthly premiums, and critics argue that they won’t help if someone can’t afford the underlying cost in the first place. Cassidy said he doesn’t have a cost estimate, and he hasn’t worked out how to allocate the HSAs to consumers.

But Cassidy said his proposal would lower overall costs because when people are empowered to shop for their own care, they drive down prices.

Clock is ticking

Despite Trump’s comments Tuesday, lawmakers said they aren’t necessarily ready to give up bipartisan negotiations. But time is running out.

Senate Majority Leader John Thune (R-S.D.) promised Democrats a vote in the second week of December, and the enhanced tax credits expire at the end of the year.

Any legislation that would pass this year will need 60 votes in the Senate to overcome a filibuster.

Rep. Don Bacon (R-Neb.) said the only way to avoid a major premium spike is to do a one-year extension of the enhanced subsidies with minor changes to appease conservatives and make bigger reforms later.

“I think there should be better solutions down the road, but we got to make a decision pretty quick, otherwise, people’s premiums are going up,” Bacon said. “I don’t see another way out, other than some kind of modified tax credits.”

Thune on Tuesday acknowledged he wasn’t sure if Trump’s comments effectively shut the door on bipartisan negotiations on a subsidy extension.

“The question is going to be, would the Democrats accept applying Hyde to any changes and reforms that might be made?” Thune said, referring to GOP demands for stricter anti-abortion limits for the subsidies. “We’ve got members, and a lot of members, who are very interested in addressing the affordability of health care. The question is, what’s the best way to do it, and can it be done in a way that is bipartisan?”

The health advocacy coalition Keep Americans Covered (KAC) said in a briefing Tuesday that while different ideas on health insurance affordability are welcome, extending the enhanced ACA tax credits is the only realistic, viable option.

Open enrollment has been in effect for more than two weeks now, and customers have roughly a month to sign up if they want coverage at the start of next year.

“We understand there are other reforms and elements of the health care system that lawmakers want to address. The families who rely on health care tax credit do not have time to wait for Congress to figure this out. They need action right now, or these families and small-business owners will pay the price,” said Lauren Aronson, KAC’s executive director.