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In a speech on the last day of the 2026 ACA open enrollment period, President Donald Trump announced the “Great Healthcare Plan” he intends to introduce. Trump announced that his plan would change how pharmacy benefit managers (PBMs) would pay other health benefits entities, including insurance brokers. He went so far as to say that he would eliminate the “giant kickbacks” that insurance brokers receive from PBMs. However, Trump gave no other details about his views on PBMs during his speech. Likewise, the online fact sheet accompanying the proposal contains no references to PBMs.
Trump highlighted the following elements of the Great Healthcare Plan:
- Sending subsidy payments from federal programs directly to consumers rather than to health insurance companies;
- Funding the Affordable Care Act (ACA) cost-sharing reduction program, which is designed to reduce costs for low-income people purchasing insurance through the ACA public exchange;
- Mandating that all health insurers provide public rate and coverage comparisons in English;
- Requiring insurance companies to post detailed information on the use of revenue to pay claims, denial rates, the number of denials overturned on appeal, and wait times for routine care;
- Requiring hospitals that bill Medicaid or Medicare to post detailed price information publicly;
- Making common and safe prescription drugs available as over-the-counter drugs;
Trump’s proposed healthcare plan appears to focus on White House priorities of price transparency, particularly with respect to prescription drug prices, and PBM oversight. The plan also reflects Republican efforts to funnel cash payments to consumers rather than to medical providers, government programs, or private insurance companies.
According to Trump, funding the ACA cost-sharing reduction program would cut ACA exchange plan premiums and federal spending in general by at least $36 billion. He characterized the current subsidy program as a “flagrant scam” that does nothing but use billions in taxpayer subsidies to increase insurance company stock prices. In contrast, Trump claimed that sending subsidies directly to consumers would enable them to purchase their own health care coverage at a lower cost.
The move comes amid millions of ACA exchange system users who will be paying far more out-of-pocket for health insurance coverage after a temporary pandemic-era subsidy boost expired on December 31, 2025. The subsidy expiration led to particularly sharp premium increases for users with incomes over 400% of the federal poverty level. For instance, some have claimed that their family’s coverage costs would increase to more than $50,000 in 2026 from less than $7,000 in 2025.
Congress previously came close to passing a PBM oversight bill in 2024, but Elon Musk and President Trump took steps to kill the bill because they viewed the broader legislative package as overly large, “pork-filled,” and packed with unrelated spending provisions, rather than a focused reform measure.
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