Trump health plan raises key questions

Nov 25, 2025

Driving the Day

President Donald Trump speaks during a roundtable in the State Dining Room at the White House.

Donald Trump has a proposed health care plan, but it's unclear when he will make it public. | Francis Chung/POLITICO

TICKTOCK — President Donald Trump was set to release his new health care plan on Monday afternoon, but the White House delayed the unveiling amid GOP pushback to the proposal, which is expected to include a two-year enhanced Obamacare subsidy extension, POLITICO’s Jordan Carney, Cheyenne Haslett, Benjamin Guggenheim and Alice Miranda Ollstein report.

White House press secretary Karoline Leavitt said Monday that Trump remained focused on “unveiling a health care proposal” but declined to get into specifics about subsidy extensions or a timeline for the rollout: “I’ll let the president speak for himself.”

The plan was expected to propose extending the Affordable Care Act tax credits — set to expire at year’s end — with new income caps for enrollees to qualify. Enrollees would also pay a minimum premium payment, and the plan would call on Congress to appropriate funds for cost-sharing reductions, which policy experts said could lead to lower premiums for some plans but also reduced financial assistance for some middle-income enrollees.

Why it matters: The expected proposal is already ruffling GOP feathers as more conservative lawmakers want to let the subsidies lapse and others have proposed alternatives to extending the tax credits, including redirecting the funding toward health savings accounts that Americans could use to purchase health care — an approach Trump has endorsed.

One House Republican granted anonymity to speak freely said in an interview Monday that they needed to see “what structural changes” Trump might float, adding that GOP lawmakers should demand “reforms … in exchange for extending the subsidies.”

Key questions: Whether the White House could rally enough support behind its proposal is a big question mark, as the GOP remains divided over a path forward on health care and as Democrats have pushed for a clean extension of the enhanced subsidies. It’s also unclear whether insurers, who’ve been lobbying hard for an extension all year, will celebrate the expected plan.

Some of the proposals Trump was preparing to put forward, including requiring enrollees to pay a minimum premium, could lead to lower overall ACA enrollment — a key concern of insurers and patient advocate groups in the fight to extend the enhanced subsidies, policy experts said. About half of ACA enrollees currently pay no premiums because of tax credits.

“There are concerns that when you add any amount of premium to someone who was previously paying nothing, people might not realize that that’s now a requirement to keep their coverage,” said Louise Norris, a health policy analyst for healthinsurance.org. That is “not necessarily because people couldn’t afford paying a few dollars a month, but just because they either didn't know they had to, or they forgot,” she added.

The timing: With open enrollment well underway, it’s likely too late for health insurers to update their underlying 2026 premium rates, which are projected to rise on average by about 26 percent, if Congress agrees to extend the subsidies. But that doesn’t mean it’s too late for a last-minute deal to make a difference in what consumers pay, policy experts said.

They pointed to the creation of the enhanced Obamacare subsidies, which then-President Joe Biden signed into law in the American Rescue Plan in March 2021 after ACA open enrollment ended. The subsidy enhancements were backdated to Jan. 1, and the federal government established a special enrollment period for consumers to take advantage of the premium assistance. The Trump administration could do something similar if Congress extends the subsidies in the next few months.

Even so: Time is still of the essence for insurers to avoid huge coverage losses, policy experts said.

“With each passing day, some people are, no doubt, making decisions to drop their coverage because of the eye-popping out-of-pocket premium increases they’re seeing,” said Larry Levitt, executive vice president for health policy at KFF.

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Telehealth

German pensioner Renate Krause, aged 71, looks at her smartphone at her home in Kiel, northern Germany.

If telehealth flexibilities established during the pandemic aren't extended, Medicare beneficiaries could face reduced access to virtual doctor's visits. | Raphaelle Logerot/AFP via Getty Images

TELEHEALTH’S ROLE — The American Telemedicine Association is making the case that telehealth use among Medicare enrollees has a nominal effect on increasing health care use and federal spending.

In a new report, the organization found that telehealth can largely replace in-person care instead of adding to the number of doctor’s office visits among seniors. Even amid a nearly 32-fold increase in telehealth visits across 1.67 million Medicare enrollees from 2019 to 2023, total visits per Medicare beneficiary remained largely unchanged, the report found.

Why it matters: The report’s release comes as pandemic-era flexibilities for Medicare telehealth coverage are set to expire Jan. 30. The flexibilities eliminated geographic restrictions on virtual care and allowed all eligible Medicare providers to offer telehealth, among other expansions.

If the flexibilities expire, telehealth coverage will largely be limited to select services or to patients living in rural areas. Extending the flexibilities has carried wide bipartisan support, but cost has been a barrier to making the coverage permanent.

Key context: Nearly three-quarters of virtual visits replaced rather than added to existing care, exceeding the nonpartisan Congressional Budget Office’s assumptions of 30 to 50 percent, according to the report. Preliminary evidence in the report also suggests that health systems’ costs remain stable or decrease with telehealth adoption.

At the White House

THE AI PUSH — President Donald Trump wants the nation’s science agencies to embrace artificial intelligence so they can turbocharge their research capabilities, POLITICO’s Brendan Bordelon reports.

Trump signed an executive order Monday to launch what’s being billed as the “Genesis Mission” — a new plan that directs the Department of Energy and other science agencies to aggressively deploy AI.

Michael Kratsios, head of the White House Office of Science and Technology Policy, described it as “the largest marshaling of federal scientific resources since the Apollo program.” In a call with reporters, he said the program is expected to accelerate the rate of scientific breakthroughs in areas such as pharmaceuticals, energy production and engineering.

The order directs agencies to make their datasets easier to read with neural networks, or machine-learning models, and other AI tools. Government-held scientific data and federal computing infrastructure will be available to university researchers, private companies and national security practitioners.

Health Costs

THE COST STRUGGLE — Many Americans struggle to manage health care costs, but those who voted for Kamala Harris in the 2024 presidential election and those who plan to vote for Democrats in the midterms reported more difficulty with the costs, according to new polling from POLITICO.

The POLITICO Poll conducted in mid-November found that nearly half of U.S. adults reported that it’s “difficult” or “very difficult” to afford health care. Of respondents who voted for Harris, 47 percent reported some degree of difficulty affording health care, compared with 44 percent who voted for President Donald Trump.

Why it matters: The polling comes as congressional Democrats and Republicans are locked in a battle over how to deal with spiking health insurance premiums.

More findings: Half of the people who plan to vote for Democrats in the midterms reported having trouble affording health care, compared with 43 percent of respondents who plan to vote for Republicans. Forty-three percent of undecided midterm voters said they experienced some degree of difficulty.

Poll respondents said they were more likely to trust Democrats to bring down health care costs, with 42 percent favoring Democrats on the issue, compared with 33 percent favoring Republicans.

Methodology: The POLITICO Poll of 2,098 U.S. adults was conducted online from Nov. 14 to 17.

Key context: One White House official, granted anonymity as a condition of speaking with reporters, said money from this summer’s One Big Beautiful Bill Act will help fund the project.

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