The Trump administration’s Great Healthcare Plan marks a shift to prioritize American patients above systems, proposing actionable reforms to realign healthcare around patient needs. Congressional support through a future reconciliation package can cement this patient-first direction.
For decades, the American healthcare system has relied on giant systems to manage and pay costs. As a result, healthcare now consumes nearly one-fifth of the economy and costs up to $15,000 per person each year. Over time, government priorities shifted from patient advocacy to supporting bureaucratic programs and increasing government involvement in every aspect of healthcare spending and decision-making. Combined, these trends have created a system where patients come last. Trump’s Great Healthcare Plan seeks to alter that equation.
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Rather than follow the example of his predecessor, Trump called for an end to the Obamacare subsidies to health insurance companies and directed those dollars to the patient instead. Ninety-three percent of Affordable Care Act enrollees receive federal subsidies, according to the Centers for Medicare & Medicaid Services (CMS). Congress can shift the requirements in the tax code to allow these tax credits, which go from the Treasury to insurance companies, to be given to patients, giving them more flexibility and control over how they spend their health dollars.
The Trump administration is also ending freeloading by wealthy countries and healthcare companies. Americans pay nearly three times more than other countries for the same drugs. As the largest buyer, Americans deserve the best pricing. The Great Healthcare Plan and TrumpRx have prompted steep reductions in the prices American patients pay for drugs developed with U.S. tax dollars.
The Great Healthcare Plan addresses some of the most insidious ways middlemen freeload off American patients. These “middlemen” (pharmacy benefit managers) dominate access to the prescription drug market, giving them power over formulary and pricing decisions. This costs patients billions of their health dollars through rebate arrangements that drive up drug prices. For example, a union may use an insurance broker or consultant to help design its members’ health insurance plan, including which middlemen to use. The union trusts that the consultant has their best interest at heart, but the consultant gets paid by the middlemen every time they sell a plan that directs to both the middleman and the middleman’s choices.
The Great Healthcare Plan addresses a central conflict of interest: Middlemen benefit at patients’ expense. The plan puts an end to this behavior by urging Congress to make these middleman payments transparent to the union or employer, and second, by asking Congress to end these payments altogether. That means a patient can purchase a health plan that’s responsive to their own needs, rather than the bottom line of a middleman. As a result, employers and patients can choose plans tailored to them, not driven by broker profits. Policymakers must continue advancing these reforms so all patients can truly control their healthcare spending.
Another issue is that Obamacare insurers deny nearly 20% of claims, yet patients rarely see this information before choosing the plan that is right for them.
That’s why the Trump administration requires these companies to shift back towards the patient, like the Plain English Standard, or the requirement that patients know the number of claims denied and how much they spend on healthcare. Bureaucrats may say that patients don’t need to know these things, but both Congress and CMS could take an important step by including these provisions in the Notice of Benefit and Payment Parameters and by amending the law to give patients more control over their health dollars.
Expanding Health Savings Accounts would continue to forward that agenda. Allowing patients to use pre-tax dollars on their health expenses grants them more flexibility and control.
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Lastly, the Great Healthcare Plan builds on Trump’s price transparency legacy by taking the landmark No Surprises Act further: Patients should see health costs before their visit, and companies should post prices like they would for any other service. Some estimate that this transparency, aligning health care prices with other sectors, could save Americans a trillion dollars.
The Make America Healthy Again initiative aims to empower Americans with both the information and tools needed to take charge of their health. To put patients first, Congress should make permanent the reforms in the Great Healthcare Plan, which target freeloading, expand patient tools, and increase transparency to achieve a patient-first system.
