In a high-stakes 2026 State of the Union address, President Donald Trump delivered a scathing critique of the Affordable Care Act (ACA), labeling it a “flagrant scam” designed to enrich insurance companies while “draining the wallets” of American families.
The President used the prime-time platform to advocate for a radical restructuring of the U.S. health system through his signature proposal, “The Great Healthcare Plan,” and the recently launched TrumpRx platform.
The “Unaffordable Care Act” and the Big Insurance Pivot
Trump argued that the current marketplace serves corporate stock prices rather than patients, pointing to the recent January 1 expiration of enhanced tax credits that has seen some middle-class premiums double or triple.
- Direct-to-People Payments: The centerpiece of Trump’s new vision is a plan to stop government “payoffs” to insurance companies. Instead, the administration proposes sending that subsidy money directly to citizens to deposit into personalized Health Savings Accounts (HSAs).
- Consumer Choice: “You take the money and buy your own healthcare,” Trump told the chamber. “The big insurance companies lose, and the people of our country win.”
- HSA Expansion: Under 2026 regulations, all Bronze and Catastrophic plans have been updated to be HSA-eligible, allowing even those with high-deductible plans to use tax-advantaged funds for out-of-pocket costs.
TrumpRx: The “Most-Favored-Nation” Push
Addressing the soaring cost of prescription drugs, Trump touted the launch of TrumpRx.gov. The platform aims to provide Americans with “Most-Favored-Nation” (MFN) pricing—essentially matching the lowest prices drugmakers charge other developed nations.
Key Price Drops Highlighted:
| Medication | Old Price (Approx.) | TrumpRx Price (Starting at) |
|---|---|---|
| Ozempic/Wegovy | $1,028 – $1,349 | $199 |
| Zepbound | $1,088 | $299 |
| Gonal-F (Fertility) | $2,000+ (per cycle) | $168 (per pen) |
| Bevespi (COPD) | $458 | $51 |
| Insulin Lispro | Variable | $25 |
Note: Trump claimed drug prices were being slashed by “300%, 400%, and 500%.” While the discounts are significant, critics and fact-checkers noted that prices cannot technically be cut by more than 100% without the manufacturer paying the customer to take the drug.
“The Great Healthcare Plan” Pillars
The President called on Congress to codify his executive actions into a permanent legislative framework based on four “transparency” requirements:
- “Plain English” Standards: Forcing insurers to ditch jargon and publish simple side-by-side coverage comparisons.
- Profit & Denial Disclosure: Requiring companies to publicize how much they spend on care vs. overhead, as well as their claim denial rates.
- “Price on the Wall”: Mandating that any hospital or provider accepting Medicare/Medicaid must prominently post all prices upfront.
- Ending PBM Kickbacks: Eliminating the hidden fees paid by Pharmacy Benefit Managers to brokers that Trump blames for “deceptively” raising premiums.
Political Backlash
The speech was met with immediate resistance from Democrats. Senator Kathy Castor and others highlighted the “GOP Health Care Crisis,” arguing that by letting ACA subsidies expire at the end of 2025, the administration has priced over one million Americans out of coverage entirely. Critics contend that the “Great Healthcare Plan” lacks a detailed legislative text and relies on voluntary deals with pharmaceutical companies that may not be sustainable or nationwide.