If you’re confused by the flood of health care headlines lately, you’re not alone.
On Jan. 15, 2026, President Donald Trump rolled out what the White House is calling the “Great Healthcare Plan,” pitching it as a way to send health care money “directly to you” instead of to insurance companies.
Under this plan, the federal government would stop sending advance tax credits to consumers’ insurers to reduce their premiums and instead send this money “directly to eligible Americans to allow them to buy the health insurance of their choice.”
Sounds appealing? It could be, but so far, the plan is short on specifics. There’s no clear explanation of who would get the money, how much it would be, or when payments would start. What’s missing are the finer details and until Congress writes and passes legislation, this is still just a framework. Here’s what to know about the “Great Healthcare Plan.”
The White House says the proposal is meant to:
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Lower drug prices by locking in “most-favored-nation” pricing and allowing more medications to be sold over the counter
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Reduce insurance premiums by ending government subsidies to insurers and instead give the money directly to individuals to buy coverage for themselves. The administration points to a cost-sharing reduction program it says could lower premiums on the most common Obamacare plans by more than 10%
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Require more transparency from insurers, including disclosures about prices, profits, claim denials and wait times
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Require hospitals and providers to share prices up front so patients get more transparency and accountability
For many Americans, health care just got a lot more expensive regardless of what happens next.
The amount health insurers charge for coverage on the ACA Marketplaces is rising 26%, on average, in 2026, according to KFF, a health policy research group (1). At the end of 2025, enhanced Affordable Care Act (ACA) subsidies, which helped millions of people keep premiums low, expired after Congress failed to extend them. Signups were down more than 800,000 from last year, official data showed.
Here’s what the math looks like according to KFF: In 2025, subsidized ACA enrollees paid about $888 per year on average. In 2026, that average rose to about $1,904, a 114% increase.
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In promoting his plan, Trump has emphasized the idea of cutting out insurers altogether, saying, “The government is going to pay the money directly to you. You take the money and buy your own health care.”
However, there’s concern that the new amount that consumers will have to manage themselves will not match what has been lost in enhanced subsidies or current existing premium tax credits.
Some Republicans and Trump have previously supported replacing ACA subsidies with $1,000 to $1,500 a year in Health Savings Accounts (HSAs).
This sum “really pales in comparison” to what many enrollees, especially those 50 to 64, had received from enhanced ACA subsidies, Matt McGough, an Affordable Care Act policy analyst at KFF, told CNBC (2). He did the math in October and found that this year, a 64-year-old with an income just above the subsidy cutoff of $62,700 could pay more than $11,000 more annually for coverage (3).
“He’s boosting a plan to send people a small check instead of doing the one thing that would actually lower health care costs: extending the health care tax credits that make coverage affordable,” said Protect Our Care president Brad Woodhouse in a statement. “Calling this a solution doesn’t make it one. For the millions of Americans facing skyrocketing costs and disappearing coverage, this isn’t help — it’s a joke.”
The health care advocacy organization said the plan to hand out cash is a “distraction” and will “fail to stop premiums from doubling and tripling, drown working families and those with pre-existing conditions in medical debt, and enrich only the wealthy.”
According to CNBC, Nick Fabrizio, a health policy expert and associate teaching professor at Cornell University’s Jeb E. Brooks School of Public Policy said, “I feel very strongly that if you give people money, they will spend it on things other than health care unless it’s like a voucher.”
Experts at KFF are also concerned about what the impact would be on people with pre-existing conditions who rely on the ACA markets.
The proposed “Great Healthcare Plan” right now is an idea that could take months, or longer, to turn into law, if it moves forward at all, so it’s important to remember that it shouldn’t be counted on as a cash windfall. There’s no guarantee direct payments will ever arrive, and if they do, they could be smaller than the subsidies many people just lost.
While Affordable Care Act open enrollment is over in most states, you could still qualify for a special enrollment period if you’ve had a major life change, like losing job-based coverage, getting married or moving.
If your premiums jumped this year:
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Shop around in your marketplace since changing plan tiers can sometimes lower costs
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Look into HSAs or other tax-advantaged options if they make sense for your situation
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Keep an eye on Congress, since any changes would have to start there
“Direct payments” may sound appealing, but for now they’re just a proposal. The subsidies that actually lowered costs are gone, and nothing has replaced them yet.
For now, a smart move is to focus on the coverage options you have today, understand what you’ll pay in 2026, and consider working with a professional to make sure you’re getting the best deal available.
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
KFF (1); CNBC (2); KFF (3)
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
