White House unveils "The Great Healthcare Plan" proposing drug-price cuts, premium reductions, and direct payments to individuals

In this context, “most‑favored‑nations (MFN) drug pricing” means the U.S. would aim to pay no more for a brand‑name drug than the lowest price that drug sells for in any other comparable developed country. Under Trump’s 2025 executive order and follow‑on agreements, the administration is:

• Calculating an MFN “target price” for each covered drug based on the lowest price in peer countries.
• Pressuring or contracting drug makers to match that MFN price for U.S. government programs (starting with Medicaid) and for direct‑to‑consumer sales via TrumpRx.
• Seeking to have Congress “lock in” this system in statute as part of The Great Healthcare Plan so that MFN pricing applies more broadly and can’t easily be reversed.

So MFN here is a negotiated/contractual benchmark (and would become a legal cap if Congress enacted it), not an automatic formula already written into law for all drugs.

TrumpRx.gov is an official federal website and program that lists discounted prescription prices and then sends patients to drugmakers’ own sites to complete purchases at those negotiated prices. The government site itself does not sell or ship medicines; it functions as a price‑comparison and referral portal for drugs covered by MFN‑based agreements.

According to the TrumpRx site and independent explainers, TrumpRx is being rolled out in early 2026. The site is live but the full direct‑purchase functionality and list of covered medicines are being phased in as companies’ agreements take effect, so availability is initially limited to specific drugs from manufacturers that have signed onto the program.

The article describes the concept but not the mechanics in legal detail. It says the administration would:

• Stop certain existing federal payments that now flow to insurers under the Affordable Care Act; and
• Instead “put extra money straight into the healthcare savings account in your name,” from which you would buy your own coverage.

That implies a model where federal subsidies are deposited into individual health‑savings‑account‑style funds rather than being paid directly to insurers. However, the White House has not yet released statutory or regulatory text specifying whether this would operate as a refundable tax credit, advance monthly subsidy, direct Treasury deposit, or some other mechanism. Those implementation details would have to be written into the legislation Congress is being asked to pass.

The Great Healthcare Plan speech states that it would:

• End “giant kickbacks to insurance brokers and corporate middlemen that only drive up the costs,” and
• Stop “government payoffs to big insurance companies,” redirecting that money into individuals’ own health‑savings‑account‑style funds.

In practice, “kickbacks” appears to refer to commission and bonus structures paid by insurers (and sometimes pharmacy benefit managers) to brokers and other intermediaries, which are typically funded out of premiums and can increase plan costs. Research shows broker commissions for fully‑insured health plans are often a percentage of premiums, creating incentives toward higher‑priced coverage.

However, the White House has not published a detailed list of which specific ACA or other federal payments (e.g., premium tax credits, reinsurance, risk‑adjustment transfers, broker commission pass‑throughs) would be legally altered or prohibited. Without bill text, it is not yet clear exactly which payment streams would be eliminated or capped, or how broker compensation rules would be rewritten. So the directional change—reducing insurer and broker payments and shifting subsidies into individual accounts—is described, but the precise market‑structure changes are not fully specified.

Major pieces of the plan go beyond what existing executive authority clearly allows, so Congress would have to:

1. Pass authorizing legislation that:

   • Writes MFN drug‑pricing rules (or authority to set MFN‑based caps) into statute for federal programs and potentially for TrumpRx direct sales.
   • Creates or expands individual health‑savings‑account‑type vehicles, and authorizes federal dollars that now go to insurers to instead be deposited into people’s accounts.
   • Specifies which ACA subsidy and payment mechanisms are modified or repealed, and how new subsidies are structured.
   • Re‑establishes and appropriates ongoing funding for ACA Cost Sharing Reduction (CSR) payments to insurers.
   • Mandates the expanded transparency requirements on insurers and providers (price posting, claims‑denial reporting, payout‑vs‑profit disclosure) as conditions of doing business and/or participating in Medicare and Medicaid.

2. Provide appropriations and enforcement authority, including:

   • Budget authority for CSR payments and any new subsidies/federal deposits.
   • Civil monetary penalties and oversight powers for HHS/CMS and potentially the Departments of Labor and Treasury to enforce transparency and MFN provisions.

Earlier Trump‑era transparency and MFN efforts relied on executive orders and administrative rulemaking, some of which were litigated. Codifying this framework at the scale described in The Great Healthcare Plan would require new federal statutes.

Under the Affordable Care Act, Cost Sharing Reductions (CSRs) are extra subsidies that lower deductibles, copays, and other out‑of‑pocket costs for low‑ and moderate‑income people (100–250% of the federal poverty level) who enroll in Silver‑level marketplace plans. Insurers must provide these richer benefits, and the federal government is supposed to reimburse them for the added cost.

From 2014–2017 the federal government made CSR payments directly to insurers. In late 2017 the Trump administration halted those payments without changing insurers’ legal obligation to provide the extra benefits, so insurers raised Silver plan premiums to cover the unfunded cost—a practice called “silver loading.” Because premium tax credits are tied to Silver plan prices, this pushed federal spending on premium subsidies up and Silver premiums for unsubsidized enrollees sharply higher.

Analyses by KFF and others show that if Congress appropriates CSR funding again, insurers would no longer need to load CSR costs into Silver premiums. That would allow Silver premiums—the benchmark for many ACA plans—to fall back toward the level they would have been without CSR defunding. KFF estimates that appropriating CSR funding would reduce average Silver premiums roughly in the 10–15% range, which is the figure the White House cites when it says fully funding CSRs would cut premiums on popular Obamacare plans by that amount.

The plan would build on and broaden existing federal transparency rules and tie them to participation in Medicare and Medicaid. According to the White House article, it would:

• Require any insurer or hospital that accepts Medicare or Medicaid to:
  • “Prominently post all prices” at their place of business (and, by implication, online) so patients can comparison‑shop.
  • Publish “rate and coverage comparisons in very plain English.”
  • Disclose “how much of your money they’re going to be paying out in claims versus how much they are taking in in profits,” and
  • Release detailed data on claim denials and how often denials are overturned on appeal.

Existing CMS rules already require hospitals and most private health plans to post machine‑readable price files and, for plans, to provide cost‑estimate tools, enforced through audits and civil monetary penalties. CMS has fined non‑compliant hospitals and recently increased maximum penalties into the millions of dollars per hospital.

Under The Great Healthcare Plan, Congress would be asked to codify and extend such requirements, making this transparency a statutory condition of participating in Medicare and Medicaid for both private insurers and providers. Enforcement would likely mirror current CMS practice—monitoring, warning letters, and escalating civil penalties—but the exact enforcement structure, penalty sizes, and appeal rights have not yet been specified in public legislative text.