Former President Donald Trump is preparing to roll out a new proposal aimed at curbing rising health care costs as early as Monday, according to three sources familiar with the discussions. The effort comes as the administration races to prevent steep premium hikes expected from the expiration of enhanced Affordable Care Act (ACA) subsidies.
The new framework is intended to make good on Trump’s promise to offer an alternative to the boosted ACA subsidies currently supporting nearly 22 million Americans. Democrats have refused to reopen the government without a clean extension of the subsidies, resulting in more than a month of congressional gridlock.
In a recent deal to keep the government funded through January, Senate Republicans agreed to hold a vote in mid-December on extending the enhanced subsidies — which are scheduled to end this year. That agreement has prompted Trump and his team to craft a competing health care vision.
The expanded subsidies, first introduced in the 2021 Biden COVID-19 relief package, significantly lowered marketplace premiums. If they expire, premiums could more than double in 2025, according to KFF, while the CBO estimates that 2 million more Americans would become uninsured.
Democrats are already signaling plans to use the potential fallout as a political weapon in the upcoming midterms — just as they successfully did in 2018, when GOP efforts to repeal the ACA contributed to Republicans losing the House.
The White House emphasized that Trump has not finalized his proposal. “Until President Trump makes an announcement himself, any reporting about the administration’s health care positions is mere speculation,” a spokesperson said.
What the Developing GOP Plan Could Include
While still in flux, the version under consideration would temporarily extend ACA subsidies but with tighter controls — including:
- Restoring income caps for eligibility
- Requiring all enrollees to pay some premium, eliminating $0 plans
- Potentially redirecting federal aid into Health Savings Accounts (HSAs)
These guardrails target two long-standing GOP criticisms:
- Zero-premium plans lead to fraudulent enrollments
- Middle-income Americans have benefited disproportionately from enhanced subsidies due to the removal of income caps
Restoring the 400% poverty-level income ceiling — which existed before 2021 — would again limit assistance for the middle class, the group most financially exposed if enhanced subsidies lapse.
The proposal requiring even low-income consumers to pay a minimum monthly premium seeks to combat widespread reports of brokers enrolling or switching people into plans without consent to earn commissions.
Possible Shift Toward Health Savings Accounts
Another major component being considered would give consumers more control over federal assistance.
Trump has repeatedly advocated for subsidies to be paid directly to individuals, rather than routed through insurance companies. This aligns with proposals from GOP Senators:
- Rick Scott — would allow people to put all their federal aid into HSAs and even purchase non-ACA plans
- Bill Cassidy — would shift only the enhanced subsidies into HSAs, allowing the funds to cover services like prescriptions, doctor visits, and eyewear
A related proposal from the Paragon Health Institute would allow lower-income consumers to deposit cost-sharing assistance — subsidies that reduce deductibles and out-of-pocket expenses — into HSAs. It also recommends Congress reinstate federal funding for these payments, which would help lower premiums for certain ACA plans.
Other conservative health policy ideas, including expanding access to non-ACA insurance options, may also appear in Trump’s framework.
Meanwhile, Trump is expected to urge Congress to enshrine his “Most Favored Nation” prescription drug policy, which pegs U.S. prices to lower rates paid in comparable countries. The policy helped secure voluntary pricing agreements with pharmaceutical companies during his term.
The new health care package, once unveiled, is poised to reignite a central political battle over the ACA — one that has defined U.S. health policy debates for more than a decade.
