"Great Healthcare Plan" unveiled Jan 14: redirect subsidies to HSAs, MFN drug pricing, transparency mandates. ACA catastrophic plan proposal: $15K/$31K deductibles, lower premiums, 2M could drop coverage. "One Big Beautiful Bill" Medicaid: work requirements 80hr/month (2027), retroactive coverage cut to 1 month, $35 copays. Premiums $888 to $1,904/month without subsidies. Medicare trust fund exhaustion moved to 2040. SOTU: Trump pledged to "always protect" Social Security, Medicare, and Medicaid.
"Great Healthcare Plan" (Jan 14, 2026): Redirect ACA subsidies to HSA-style accounts, implement Most Favored Nation (MFN) drug pricing (match lowest international prices), expand price transparency mandates for hospitals and insurers, create cross-state insurance purchasing.
ACA catastrophic plan proposal: New ACA "copper" tier with $15,000 individual / $31,000 family deductibles. Lower monthly premiums but dramatically higher out-of-pocket costs. CBO estimates 2 million people could drop comprehensive coverage for catastrophic plans, leaving them financially exposed for routine care.
"One Big Beautiful Bill" Medicaid provisions: Work requirements of 80 hours/month beginning 2027 for non-disabled adults 19-64. Retroactive coverage eligibility cut from 3 months to 1 month. New $35 copays for ER visits and certain services. Annual redeterminations tightened. States given waiver flexibility to add additional requirements.
Premium impact: Without ACA enhanced subsidies (expired end 2025), average benchmark Silver plan premiums rose from $888/month to $1,904/month for a 60-year-old earning $32K/year. 1.4 million fewer enrollees in 2026 open enrollment compared to 2025.
Medicare trust fund: Exhaustion date moved to 2040 (from projected 2036) due to prescription drug negotiation savings. 9 million seniors saving 50%+ on negotiated medications.
SOTU (Feb 26, 2026): President Trump pledged to "always protect" Social Security, Medicare, and Medicaid -- a significant statement given the One Big Beautiful Bill's $1 trillion in Medicaid cuts over a decade. Advocates note the tension between the pledge and the enacted legislation.