In brief: Trump’s ‘Great Healthcare Plan’ | Nat’l healthcare spending | Working families and healthcare affordability

President Trump unveiled his ‘Great Healthcare Plan’ Jan. 15. It’s largely an exercise in thinking out loud since it can’t propel anything consequential without legislative action in Congress.

Still, the plan—and the reactions it’s eliciting—warrant a look. 

• The plan document emphasizes care affordability and outlines the White House’s wish list under four major aims. These are reduce drug prices, lower insurance premiums, maximize price transparency and “hold big insurance companies accountable.” It also proposes cutting off subsidies to insurance companies and, instead, sending money directly to eligible Americans so they can “buy the health insurance of their choice.” 
   
• In a video promoting the unveiling, President Trump suggests the plan stands to “truly make healthcare affordable again.” “You’re going to get a better deal and better care,” he says. “I'm calling on Congress to pass this framework into law without delay. We have to do it right now so that we can get immediate relief to the American people, the people I love.”
   
  • Here’s a sampling of initial reactions making the news.  
     
• “Time and again, Donald Trump has made empty promises to the American people about lowering their healthcare costs. [T]oday’s announcement is no different. … [A]re you paying more for your healthcare than you were a year ago? The answer ought to tell you everything you need to know about the Trump-Republican healthcare agenda.”—Sen. Ron Wyden (D-OR)
   
• “We are thankful for President Trump’s determination to lower healthcare costs. House Republicans are anxious to continue working closely with the White House every day to deliver real results for the American people.”—Speaker of the House Mike Johnson (R-LA) 
   
• “The idea of sending money directly to the people sounds like a radical departure from the Affordable Care Act. … This provision has the potential to lead to a ‘death spiral,’ leaving many people with pre-existing conditions who don’t get coverage through their jobs without an option for comprehensive coverage.”—Cynthia Cox, senior vice president at KFF
   
• “President Trump is taking on insurers, hospitals and all middlemen. [He wants] to hold them accountable and deliver radical transparency.”—Cynthia Fisher, founder of PatientRightsAdvocate.org
   
• “It’s a broken plan and a broken idea. The average consumer doesn’t really have time to go shopping when they need to go to the hospital for a premature birth or a car accident.”—Arthur Caplan, PhD, head of medical ethics at NYU Grossman School of Medicine 
   
• “The Trump plan would be a massive redefinition of the relationship between the U.S. government, the healthcare system and the American people. Today was about resetting the vision and resetting the conversation so Republicans can talk on offense.”—Ryan Ellis, president of the Center for a Free Economy
   

U.S. healthcare spending reached $5.3T in 2024. That figure represents a 7.2% spike over 2023, when the metric showed a similar 7.4% spending increase over 2022. 

Does the trend reflect generally appropriate utilization or troublingly conspicuous consumption? 

It’s hard to say. In any case, across the 2022 to 2024 window, the primary growth driver has been steadily rising demand for health services. That’s one takeaway from a study conducted by researchers at the Centers for Medicare and Medicaid Services. Health Affairs published the work Jan. 4. “In the U.S., healthcare is financed by households, private businesses and governments,” CMS statistician Micah Hartman and co-authors note. “These entities are the ultimate sponsors of the nation’s healthcare bill and finance health spending such as out-of-pocket deductibles and copayments, private health insurance premiums, and government program expenditures (such as Medicare and Medicaid).” The team also points out that the federal government is the largest sponsor of healthcare expenditures, having laid out $1.7 trillion in 2024—almost one-third of the total national outlay for the year. More data points from the study: 

• Healthcare spending continues to account for an increasing share of GDP while also outpacing GDP growth. The sector’s slice of GDP was 18.0% in 2024, up from 17.7% in 2023. “Strong overall healthcare spending in 2023 and 2024 was due to growth in personal healthcare spending, which averaged 8.9% and represented the highest rate of growth for two consecutive years in more than three decades,” Hartman and co-authors report. “The strong growth in personal healthcare over the course of these two years was driven primarily by nonprice factors such as the use and intensity of services, particularly for hospital care, physician and clinical services, and retail prescription drugs.”
   
• The insured share of the population reached a peak in 2023, at 92.5%, declining to 91.8% in 2024. A decline in Medicaid enrollment in 2024 was accompanied by enrollment gains in Marketplace plans and employer-sponsored private health insurance, the CMS number-crunchers state. Federal spending for healthcare picked up in 2024, they add, as spending growth for Marketplace subsidies increased—as did Medicare spending related to provisions in the Inflation Reduction Act of 2022. 
   
• The future of healthcare spending remains uncertain. “Although some of the recent factors affecting utilization and insurance coverage might not persist, health spending trends are certain to be affected by future economic and demographic changes, as well as by new technologies and innovations,” Hartman et al. write. “For example, developments in artificial intelligence and cancer treatment, as well as expanding policies and use around weight-loss treatments and other healthy behavior initiatives, may affect the healthcare system in unexpected ways.”
   
  • Health Affairs is published by the nonprofit Project HOPE, and the study is posted in full for free.
     

In 2024 the typical working family—meaning one with at least one worker between the ages of 18 and 64—spent close to $4,000 on health insurance premiums plus out-of-pocket expenses. 

According to analysts at the Center for Economic and Policy Research, healthcare expenditures at this level “place substantial strain on family finances, leading some families to postpone or forgo acute and preventive care, imperiling their own and the nation’s financial and physical health.” The analysts, CEPR senior research fellow John Schmitt and staff researcher Emma Curchin, concentrate on data in the Annual Social and Economic Supplement (ASEC) of the Census Bureau’s Current Population Survey (CPS). Among their most bracing observations: 

• 10% of working families with the highest levels of expenditures paid more than $14,800 out-of-pocket for their healthcare in 2024. Meanwhile 1 in 8 working families spent more than 10% of their income on healthcare. Burdens were heaviest for low-income and rural households.
   
• Healthcare costs are rising faster than inflation. And future increases in premiums, ACA costs and Medicaid cutbacks will worsen the hit to household budgets. The healthcare expenditure burden is heavy in all demographic groups and for all but the highest-income families, Schmitt and Curchin show. 
   
• High healthcare expenses not only cause financial distress but also cause care delays. In turn, these tend to drive care to emergency settings, worsen communities’ health status and incur costs of various kinds for our society as a whole, the authors suggest. Maybe most unsettling line in the report: “The estimates here are almost certainly conservative descriptions of the situation that will face working families in 2026 and beyond.”
   
  • To read it all, click here.
     

Also noteworthy:

• Controversial US study on hepatitis B vaccines in Africa is cancelled/$1.6M project had drawn outrage over ethical questions about withholding vaccines proven to prevent disease (The Guardian)  
   
• New map shows how to spot the measles risk level in your ZIP code/Hot spots show up in areas like West Texas and southern New Mexico (ABC News) 
   
• The new old age/What to expect when you’re expecting to live longer (Time multi-article package)

From HealthExec’s sibling news outlets:

• Radiology business leaders’ top lobbying priorities in 2026 (Radiology Business)
   
• Boston Scientific to acquire Penumbra for $14.5B (Cardiovascular Business)