(sigh) OK, a decade later, let's take a look at Trump's "healthcare pla."

"Lowering prices by 500%" and other big brain energy.

My son was in the 4th grade when Donald Trump first claimed to have a “much better” healthcare plan than “Obamacare” which would “cover everbody” and “save so much money.”

My son is a sophomore in college today.

Anyway, whatever; fine. Let’s take a look, shall we?

I’m mostly gonna base this on the “more detailed” explainer but I do have to address this nonsense claim in the initial press release:

CLAIM:

“Your prescription drugs will come way, way down and, under this policy, the prices of many drugs will be slashed by 300, 400 even 500% starting this month at the Trumprx.gov.”

REALITY:

(sigh) You literally can’t lower the price of drugs (or anything else, for that matter) by more than 100%. It’s mathematically impossible. You can’t to “slash the price by 500%” unless, i suppose, it means the drug company pays you 6x as much as the list price of the medication, which somehow I don’t think is what he has in mind.

OK, with that out of the way…

CLAIM:

The Great Healthcare Plan calls for codifying the Trump Administration’s Most-Favored-Nation deals to get Americans the same low prices for prescription drugs that people in other countries pay. This would build off President Trump’s landmark actions that made insulin more affordable in his first term and the successful voluntary negotiations following his recent Executive Order to lower drug prices. Voluntarily negotiated deals with HHS/CMS will be grandfathered in.

REALITY:

It was actually the BIDEN Administration (and Congressional Democrats) who ensured that insulin doesn’t cost more than $35/month for Medicare enrollees.

As for his Executive Order to “lower drug prices,” guess what?

NEW YORK, Dec 31 (Reuters) - Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts, according to data provided exclusively by healthcare research firm 3 Axis Advisors.

The number of price increases for 2026 is up from the same point last year, when drugmakers unveiled plans for raises on more than 250 drugs. The median of this year’s price hikes is around 4% - in line with 2025.

I don’t actually know a whole lot about the “Most Favored Nation” executive order he wants Congress to codify, so I’ll turn to Dr. Rob Davidson of the Committee to Protect Healthcare, from when Trump first issued this Executive Order last spring:

As an ER doc, I see patients rationing meds every day. We need lower drug prices — full stop. That’s why I support Medicare negotiating directly with pharma. But let’s talk about Trump’s new “Most Favored Nation” executive order on drug prices.

The EO sounds aggressive: tie U.S. drug prices to the lowest paid in rich countries like France or Germany. But here’s the catch: it doesn’t do anything on its own.

It tells HHS to “negotiate” lower prices within 30 days. No specifics. No enforcement. No immediate effect. Just vibes. We’ve seen this before: Trump tried this in 2020. It got blocked in court and quietly died.

Worse: just a month earlier, Trump signed a separate EO that actually delays Medicare negotiation for many pills (small-molecule drugs) from 9 to 13 years — a giveaway to pharma. One EO makes headlines. The other quietly protects profits.

So to recap: Big talk about slashing prices. No binding power. Real regulatory delays that help drug companies and keep prices high longer. This isn’t reform. It’s a press release.

CLAIM:

The Great Healthcare Plan makes more verified safe pharmaceutical drugs available for over-the-counter purchase. This will lower healthcare costs and increase consumer choice by strengthening price transparency, increasing competition, and reducing the need for costly and time-consuming doctor’s visits.

REALITY:

On this issue, I’m turning to Merrill Goozner’s writeup this morning:

Beyond asking Congress to codify international reference pricing, the plan calls for making more drugs available as cheap over-the-counter medications. While this could limit sales of a few prescription anti-acids and pain relievers, for which there are already plenty of cheap over-the-counter alternatives, it would have no impact on the high prices of biotech specialty drugs, which are the major drivers of escalating pharmaceutical spending.

Nor would it affect the slow progress in bringing biosimilars to market, or their pricing. Most biotech drugs are either injected or infused in clinical settings, which makes them inappropriate for over-the-counter sales.

CLAIM:

The Great Healthcare Plan stops sending big insurance companies billions in extra taxpayer-funded subsidy payments and instead send that money directly to eligible Americans to allow them to buy the health insurance of their choice.

REALITY:

Do I really need to explain the strained logic here? Instead of giving money to the insurance companies, he wants to give the money to you so that you can give it to the insurance companies.

In any event, as Cynthia Cox notes over at KFF:

It’s not entirely clear from the summary exactly what is meant by the proposal to “send the money directly to the American people.” The fact sheet says it would allow Americans to use the “extra” taxpayer-funded subsidies to “buy the health insurance of their choice.”

• Is it only the enhanced premium tax credit dollars that would be converted to a savings account, or are other taxpayer subsidies included in the “extra”?

• Who is eligible for this financial help and how would it be calculated and dispersed?

• Who will end up paying more and who will pay less?

• Would the funds be limited to out-of-pocket costs only or be used for premiums?

• Would any savings account money be in addition to or in lieu of premium tax credits, and would enrollees have a choice?

• Would this new financial support be available only on the ACA Marketplaces or could it be used to purchase health insurance that discriminates against people with pre-existing conditions, potentially leading to instability in the ACA Marketplace?

This last bullet is the one I’m most concerned about. If that’s what he has in mind, then what he’s really talking about is defunding ACA premium tax credits and instead giving it to people to buy non-ACA compliant junk plans which don’t include any of the ACA’s patient protections, such as...

• Being required to cover people with pre-existing conditions (Guaranteed Issue)

• Not being able to discriminate on pricing based on gender, profession or medical condition (Community Rating)

• Having to actually cover Essential Health Services such as hospitalization, emergency services, surgery, outpatient care, prescription drugs, maternity & newborn care, mental health services, rehabilitative services, pediatric care, etc.

• Having to cover a minimum of 60% - 90% (depending on the plan level) of aggregate medical claims (Minimum Actuarial Value)

• NOT having Annual or Lifetime Benefit Caps

• Having a Maximum Out-of-Pocket ceiling

• Covering Preventative Services at no out of pocket cost

• Adult children being allowed to remain on their parents policy until age 26

CLAIM:

The Great Healthcare Plan funds a cost-sharing reduction program for healthcare plans which would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10% according to the Congressional Budget Office.

REALITY:

DONALD TRUMP IS THE ONE WHO ELIMINATED CSR REIMBURSEMENT PAYMENTS IN THE FIRST PLACE back in October 2017.

More to the point, the reason why funding CSR payments would “save taxpayers $36B” is because that’s how much it would reduce ACA tax credits for millions of enrollees. Also, note the “...most common” caveat attacked to the “reduce premiums by over 10%” claim; he’s referring to Silver plans, which are the ones the ACA tax credit formula are based on.

When you reduce the gross premiums of Silver plans (only Silver plans) by 10%, guess what happens to the net premiums for Bronze & Gold plans? They INCREASE dramatically. Funding CSR payments would instantly eliminate Silver Loading,

Here’s a breakout of current ACA exchange enrollment by metal level and income bracket...

...and here’s the same table with the enrollees currently helped by Silver Loading (in yellow) vs. those who would be “harmed” by it (in green). And again, the only reason they’d be harmed at all is if the enhanced subsidies end, since that would cut everyone earning over 400% FPL from any subsidies at all:

In other words, funding CSR reimbursement payments would slightly help a few hundred thousand middle-class enrollees (who only need the help because of the enhanced tax credits expiring to begin with) while significantly harming over 5.7 million lower-income enrollees in the process.

CLAIM:

The Great Healthcare Plan will end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen that deceptively raise the cost of health insurance.

REALITY:

Again, via Merrill Goozner:

The plan also calls for Congress to end the kickbacks pharmacy benefit managers receive from large drug companies for including their products on preferred drug lists. The CBO estimated the GOP bill that passed the House in December with this reform would save drug insurance plans about $15 billion a year, a tiny fraction of the more than $300 billion that patients and their insurers spend at retail pharmacies each year.

If I’m reading this correctly, it means that not only would it only reduce gross (not net) drug prices by 5% at most, it was apparently already passed last month anyway.

CLAIM:

The Great Healthcare Plan creates the “Plain English Insurance” Standard by requiring health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English—not industry jargon—so consumers can make better insurance purchasing decisions.

REALITY:

This is literally already required under the ACA, as anyone who’s ever visited HealthCare.Gov or any of the state-based ACA exchanges over the past decade knows.

The Great Healthcare Plan will require health insurance companies to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites.

The Great Healthcare Plan will require health insurance companies to publish the percentage of insurance claims they reject and average wait times for routine care on their websites.

(sigh) The ACA already requires insurance carriers to provide claims denials & insurance overhead data publicly. For example, here’s the Centers for Medicare & Medicaid Services (CMS) own website section on Medical Loss Ratio data:

The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.

I’ve written about MLR data many, many times in the past.

CLAIM:

The Great Healthcare Plan requires any healthcare provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business.

REALITY:

(sigh) This is actually a perfectly reasonable idea...except that it was already put into place back in 2020...by the Trump Administration:

The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule requiring hospitals to release pricing information before providing services. Under the rule, hospitals must list standard prices for 300 “shoppable services,” as well as the lowest prices they will accept from consumers paying out of pocket. According to CMS Administrator Seema Verma, the new price transparency rule will help patients by boosting quality and cutting costs.

The rule defines a “shoppable service” as a health care service that consumers can schedule in advance, at times that are convenient for them. These services typically are non-urgent.

Under the rule, hospitals will be required to publicly disclose standard charges (including gross charges, payer-specific negotiated charges, charges for cash-paying patients, and the minimum and maximum negotiated charges) for all items and services. This information must be available on the internet in a single data file that can be read by other computer systems. The file must include the hospital’s billing or accounting codes, such as Healthcare Common Procedure Coding System codes, and a description of each item or service. The goal is to enable consumers to compare standard charges across hospitals.

In addition to being a hodge-podge of ideas which either a) already exist; b) don’t exist yet but which wouldn’t accomplish much; or c) don’t exist yet but which would actively make healthcare worse and less affordable than it is today, Trump’s “plan” also has the added feature of not actually being a plan.

As Dan Diamond noted over at the Washington Post:

The administration released no legislative text nor timeline for related congressional action and did not indicate whether Republican leaders support the proposal, even as health care costs loom as a central issue in this year’s closely contested midterm elections. Asked how the proposal would advance in Congress, administration officials said it was a “broad architecture” intended to guide lawmakers on next steps.

...The proposal does not include new ideas to expand health coverage or simplify America’s often-byzantine health-care system. It also falls far short of Trump’s promises to deliver a replacement for the ACA, the sweeping 2010 health law that has been credited with helping more than 20 million Americans get health coverage and has long been targeted for repeal by Trump and his GOP allies.

That’s OK, though. I’m sure more details will be released in...two weeks.