Trump pitches direct payments for health care: What policy experts say
An Obamacare sign at a Miami insurance agency on November 12, 2025.
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The White House on Thursday reiterated its support for sending payments directly to households to cover healthcare costs, an idea that President Donald Trump has championed for months.
But health policy experts reached by CNBC said they were skeptical of the proposal.
“I think it’s a bad idea,” said Gerard Anderson, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
Politics was part of a process broad outline A health plan that the White House says will lower drug prices and insurance premiums. One video Announcing the framework called the “Great Health Plan”, Trump called on Congress to quickly enact it.
Trump has shown enthusiasm for sending direct payments in other contexts during his second term, floating floating ideas including tariff dividend checks.
Experts have said it is difficult to assess the specific impact of direct health care payments because the White House framework lacks important details such as who might qualify, how much consumers could receive and how the money might be spent.
At a high level, Anderson said, it doesn’t appear that the proposal would provide the same level of financial assistance for health care that consumers already receive, which would likely lead many people to drop their insurance and increase premiums for remaining enrollees.
Strong guardrails also need to be in place to determine how people can spend their health care funds, said Nick Fabrizio, a health policy expert and associate professor at Cornell University’s Jeb E. Brooks School of Public Policy.
“I feel very strongly that if you give people money, they will spend it on things other than healthcare, as long as it’s not like a voucher,” Fabrizio said.
Fabrizio said Trump’s general framework, which calls for policies such as greater price transparency in the medical ecosystem, could be successful in lowering healthcare costs.
Trump framework arrives amid ACA subsidy debate
Senate Minority Leader Chuck Schumer (D-NY) speaks at a news conference with other members of the Senate Democratic leadership following a policy luncheon at the Capitol on October 15, 2025.
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The framework comes as Congress debates whether to do so. It could expand enhanced subsidies that lower insurance premiums for millions of Affordable Care Act members, complicating a bipartisan effort to replace them.
The increased subsidies that have been in place since 2021 expired at the end of last year. KFF, a nonpartisan health policy research group, estimated that this delay would cause premiums to more than double for the average buyer.
Without this enhancement, a subsidy basis known as premium tax credits is still in effect for ACA enrollees.
Consumers can choose to receive these premium tax credits in one of two ways: as a lump sum payment during tax season or through an immediate reduction in their monthly insurance premiums.
In the second scenario, by far the most popular, the federal government sends a consumer subsidy to the insurance company, which lowers the consumer’s upfront premium.
Trump’s healthcare framework called for an end to “billions of dollars of extra taxpayer-funded subsidy payments” and instead supported sending that money “directly to eligible Americans to enable them to purchase the health insurance of their choice.”
It’s unclear how such a plan would work, experts said.
Trump and some Republicans in Congress have previously supported the idea of repealing some or all ACA subsidies and replacing them with contributions to health savings accounts or something similar. wrote KFF’s Larry Levitt and Cynthia Cox. A health savings account is a tax-advantaged account for medical expenses.
A White House official said on Thursday: Consumers outside the ACA market will also be eligible to receive direct payments.
While HSAs can be used to cover certain medical expenses, consumers cannot currently use them to pay insurance premiums, and only consumers enrolled in a high-deductible health insurance plan can contribute to such an account, experts said.
If the HSA ban on premium payments continues, “you’re going to run into barriers to getting people in the door and getting them into an insurance plan,” said Matt McGough, an Affordable Care Act policy analyst at KFF. “It really won’t relieve a lot of things [financial] It’s a burden to these people.
“The devil really is in the details here,” he said.
The amount is an important missing detail
The direct payment amount and the extent to which remaining premium tax credits will be reduced are other important, unknown details, experts said.
If the amount isn’t large enough, those dropping coverage will generally be younger, healthier people, leaving older, sicker enrollees behind, Anderson said. Because elderly and sick enrollees often need more care, insurers will increase premiums for remaining insureds to compensate for that risk, he said.
The legislation was introduced in December by Sen. Mike Crapo, R-Idaho, chairman of the Senate Finance Committee, and Bill Cassidy, R-La., chairman of the Senate Health, Education, Labor and Pensions Committee. It was announced by. will make an annual HSA contribution $1,000 for individuals ages 18 to 49 or $1,500 for individuals ages 50 to 64.
That amount “really pales in comparison” to what many enrollees, especially those ages 50 to 64, receive from enhanced ACA subsidies, McGough said.
For example, the average middle-income 60-year-old earning almost $63,000 a year is no longer eligible for ACA subsidies and is on the line for her entire unsubsidized insurance premium in 2026 — about $15,000, one study found. KFF analysis. In 2025, the same person is eligible for an ACA premium subsidy of approximately $7,300.
Premium tax credit amounts vary widely from person to person depending on age, income and geography.
