Trump’s Not So Great Health-Care Plan

National Review Online

Friday, January 16, 2026

 

President Trump deserves credit for thus far resisting Democrats’ demands to throw more money at the failed Obamacare program. But on Tuesday, he offered a one-page policy response, characteristically titled, “The Great American Healthcare Plan,” that leaves much to be desired.

 

The outline is mostly small-bore ideas that range from inadvisable (importing socialist price controls for pharmaceuticals) to perfectly fine but inadequate (allowing more drugs to be purchased over the counter and expanding price transparency). The plan misses because ultimately it doesn’t offer a contrary vision for health care from Obamacare, which added a raft of regulations to insurance policies, making coverage vastly more expensive.

 

This problem with Trump’s approach is most evident in the centerpiece of the plan, which says that the government will “stop sending big insurance companies billions in extra tax-payer funded subsidy payments and instead send that money directly to eligible Americans to allow them to buy the health insurance of their choice.”

 

It would be great if Americans had more control over health-care dollars and had the ability to choose from more plans. Currently, health savings accounts, which would be the most likely vehicle for this sort of proposal, prevent individuals from using funds toward premiums. Reforming HSAs to allow for this would be a positive step. But absent broader changes on the regulatory front, enrollees wouldn’t have a real choice as they would still be purchasing among Obamacare plans. So this proposal wouldn’t amount to much more than a technical processing change — i.e., instead of sending money directly to insurance companies, the government would be sending it to individuals, who would then be sending it to insurance companies.

 

The only way to offer a compelling alternative is to focus on ways to reduce the regulatory burden on health insurance or, at a minimum, find a way to provide more lower-cost options to those who don’t require their health insurance to be as comprehensive. The first Trump administration made headway by expanding the use of short-term plans, an idea that Trump has recently touted but that his outline unaccountably omits.

 

To be clear, if the Trump health-care outline serves the purpose of steering antsy Republicans away from a catastrophic decision to join Democrats in expanding Obamacare, that alone would be a net positive. But as an alternative vision for health care, it isn’t big, beautiful — or great.