The longest government shutdown in history ended on Nov. 12, 2025, 43 days after the Democrats first refused to vote to fund the government based on concerns over expiring Affordable Care Act subsidies. All Americans were held hostage by this fight over the ACA, despite the fact that fewer than 10% rely on the ACA for their healthcare coverage.
In the final days of the shutdown, President Donald Trump proposed a strategy for dealing with spiraling healthcare costs: Instead of sending taxpayer subsidy dollars to insurance companies, redirect ACA subsidies directly to consumers. While he didn’t specify how this would be done, most observers have suggested this would be in the form of funding individual Health Savings Accounts.
The idea has merit; for years, insurers have continued to raise rates at a rate far faster than inflation. But it can only work if consumers have real price and quality transparency to guide their healthcare purchases. Today they don’t.
Transparency means consumers can see beforehand what a service will cost, what they will personally owe, and whether the care provided is of good quality. Today, prices are published in unusable formats, vary wildly without explanation, are hidden behind facility fees and coding tricks, and are completely disconnected from any consumer-facing measure of quality. That’s when they are provided; too often, they are not.
While the specific details of how this could work have not been fleshed out, the policy direction is clear: shift the power away from insurers to individuals. The current system allows insurers to charge as much as they want; when they raise rates, they receive more taxpayer dollars. Trump’s frustration with insurance companies was palpable in his Nov. 8 Truth Social post. Trump supports the dollars currently being routed to insurers to go directly to consumers. His comments tapped into the frustrations of consumers who feel they are being gouged and still getting suboptimal care.
HSAs are tax-advantaged accounts associated with high-deductible health plans. Consumers (and sometimes employers) fund them. While those dollars can then be used for a variety of healthcare expenses, under current law, HSA funds generally cannot be used for premiums.
The idea of cutting out the middleman and giving money directly to consumers so they can make their own decisions about how to spend their healthcare dollars is appealing in theory, but in reality, the ability to shop for healthcare fails because, in every way, price transparency is broken. How can we expect consumers to shop when they can’t see prices?
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There are laws that require insurance companies to provide documents explaining their charges, but even when they comply, the files are often incomplete, inconsistent, or intentionally opaque. “Negotiated rates” vary irrationally and provide no usable signal. Prices are detached from the true prices that patients pay; deductibles, coinsurance, and facility fees are not disclosed consistently or coherently. There is no price transparency, and therefore, it remains impossible for consumers to shop for care.
The president is heading in the right direction, but he needs to ensure that consumers not only have control over the money meant to pay for their healthcare, but also have a functioning market. This means they must have real, usable information, including cash prices, not “estimates,” algorithms, or formulas, so that they can make informed decisions. Price transparency is the missing piece that will not only allow Americans to shop more effectively but also lower costs for everyone, making those dollars go further. That’s a big policy lift, but one that will be well worth the effort.
Monique Yohanan, MD, MPH, is a senior fellow for health policy at Independent Women.
