Trump’s “Great Healthcare Plan”
President Donald Trump made a major healthcare announcement today, calling his reform framework “The Great Healthcare Plan.” But the announcement provided few details and leaves much of the work to Congress. GOP lawmakers do appear to be crafting ideas to limit exposure on healthcare unaffordability, but extending the expired enhanced subsidies may not be part of the deal.
Here is the very skeletal outline of the president’s proposals:
- Codifying both his proposed drug price models adopting most-favored-nation (MFN) pricing as well as the concessions deals he gained from 16 of 17 big drugmakers.
- Expanding over-the-counter and generic drug introduction.
- Existing subsidies in the Exchanges appear as if they will go directly to Americans in need and dollars deposited in individual Health Savings Accounts (HSAs).
- The cost-sharing reduction subsidies would again be appropriated after Trump himself zeroed it out in Trump 45. The move would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10%. A small cohort could be harmed.
- The plan would “end the kickbacks” from pharmacy benefits managers (PBMs) that are paid to what Trump calls the large brokerage middlemen “that deceptively raise the cost of health insurance.” This is a reference to big GPO buying firms, the largest owned by some of the biggest PBMs.
- The plan also would expand insurer transparency, including on medical claims denials, claims payments, wait times, prices, and more.
- Insurers would need to provide rate and coverage comparisons upfront on their websites in “plain English” to help consumers more easily shop for plans.
- Disclosure of medical loss ratios would also be mandated.
President Trump deserves a great deal of credit on drug price reform, but otherwise the deal is not well thought out and does not tackle the true reason for a lack of affordability – price in the market. I will give more details in a blog soon.
Additional articles: https://www.fiercehealthcare.com/regulatory/trump-takes-aim-insurance-industry-unveiling-great-healthcare-plan and https://www.beckerspayer.com/policy-updates/trump-pitches-healthcare-policy-outline-aimed-at-lowering-costs-3-takeaways/ and https://www.cnn.com/2026/01/15/politics/trump-health-care-plan and https://apnews.com/article/trump-health-care-insurance-congress-savings-accounts-b7b4caae9ad14fda4646c42d3858202b and https://www.cnbc.com/amp/2026/01/15/trump-congress-aca-subsidies-health-care.html and https://www.whitehouse.gov/articles/2026/01/president-trump-unveils-the-great-healthcare-plan-to-lower-costs-and-deliver-money-directly-to-the-people/ and https://www.whitehouse.gov/wp-content/uploads/2026/01/The-Great-Healthcare-Plan.pdf and https://thehill.com/policy/healthcare/5691065-trump-health-care-affordability-plan/ and https://www.healthcaredive.com/news/trump-great-healthcare-plan-affordability-aca/809759/ and https://www.medpagetoday.com/publichealthpolicy/healthpolicy/119456
(Some articles may require a subscription.)
#healthcare #healthcarereform
https://www.modernhealthcare.com/politics-regulation/mh-trump-great-healthcare-plan-drugs-premiums
MedPAC Part D PDP Report
Part D Actuary Brooks Conway posted on a great presentation by congressional Medicare policy arm MedPAC about its report to Congress regarding the standalone Part D program. You can read his LinkedIn post at the link below.
#partd #medicareadvantage
Improper Payment Estimates Released
The Trump administration released new estimates of improper payments in key government insurance programs.
It said that the estimated improper payment rate in traditional Medicare was 6.55%, or $28.83 billion, in 2025. That’s down from $31.7 billion, or a 7.66% rate. The improper payment rate in Medicare Advantage (MA) was 6.09%, or $23.67 billion, last year. That figure increased from $19.07 billion in improper payments, or a 5.61% rate. Most MA improper payments are attributable to risk adjustment overpayments.
About 4%, or about $4.23 billion, of Part D payments were improper in 2025. Medicaid has improper payments of 6.12%, or $37.39 billion, in 2025, which is a rise from 5.09%. In the children’s coverage program known as CHIP, the improper payment rate of 7.05% in fiscal 2025, or $1.37 billion, up from a 6.11% rate.
Improper payments can be either underpayments or overpayments. They do not necessarily constitute fraud, but can include situations such as missing data and administrative errors.
Additional article: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-improper-payments-fact-sheet
#medicare #medicaidadvantage #partd #medicaid #chip #fwa
Employers Struggle With GLP-1s As Interest Gains
Employer groups have been hit by the rising costs of GLP-1 weight-loss drugs and now worry that the addition of GLP-1 pills could complicate their healthcare finances even more. Both Eli Lilly and Novo Nordisk have such pills out or coming out.
Seventy percent of private sector employers covered GLP-1s for weight loss last year, but the huge surge in costs have employers rethinking coverage. And the pill forms are not dramatically cheaper. Employers are concerned about rising costs because reforms struck by President Trump on drug prices, including GLP-1s, do not directly lower employer coverage prices.
(Article may require a subscription.)
#glp1s #weightlossdrugs #drugpricing #employercoverage
https://www.modernhealthcare.com/insurance/mh-wegovy-pill-employer-health-plan-coverage
— Marc S. Ryan
