White House Unveils Sweeping Healthcare Reform Framework

Action: On January 15, the White House released the Administration’s “Great Healthcare Plan,” a framework urging Congress to enact reforms to lower prescription drug prices, reduce insurance premiums, hold large insurers accountable, and “maximize price transparency.”¹ The move comes after reforms to major health programs enacted last year prompted greater Congressional focus on increasing health care affordability.

Trusted Insights for What’s Ahead^®

• The White House factsheet lays out four broad goals for legislation to be enacted by Congress: lowering drug prices, lowering insurance premiums, increasing accountability for large insurance companies, and maximizing price transparency.² It reflects the Administration’s broader focus on reducing the role of intermediaries and redirecting Federal support more directly to consumers as health care costs and utilization rates continue to increase nationally.³
• On prescription drugs, the plan would codify the Administration’s Most-Favored-Nation (MFN) pricing approach and would build on earlier Administration actions to reduce insulin prices, while also incorporating recent voluntary drug pricing agreements negotiated with HHS and CMS. The plan also seeks to expand the availability of drugs for over-the-counter purchase under the yet-to-debut TrumpRx platform.
• The plan proposes ending what the Administration characterizes as excessive, taxpayer-funded subsidy payments to insurers and instead directing Federal assistance to eligible individuals, allowing them to purchase health insurance of their choosing. The proposal also calls for fully funding cost-sharing reduction payments for health plans, a long-standing point of contention under the Affordable Care Act.
• A central component of the plan focuses on holding insurers more directly accountable to consumers through enhanced disclosure and reporting requirements. The proposed “Plain English Insurance” standard would require insurers to publish clear, consumer-friendly comparisons of rates and coverage on their websites, alongside standardized disclosures showing the share of revenues devoted to claims payments versus administrative costs and profits. Insurers would also be required to disclose claim denial rates and average wait times for routine care, increasing visibility into plan performance and operational practices.
• The plan further expands price transparency requirements by mandating that any provider or insurer accepting Medicare or Medicaid publicly and prominently post pricing and fees at their place of business. This provision would build on existing transparency regulations and is intended to reduce surprise billing, support cash-pay options, and give patients clearer insight into healthcare costs before receiving care.
• Several elements of the Great Healthcare Plan closely track proposals from the Republican Study Committee that they are seeking to include in a broader reconciliation package.⁴ However, the narrow House margin; a lack of broad bipartisan cooperation on health care; and concerns among moderate Republicans about reopening divisive healthcare debates, particularly around Medicaid and ACA-related policies, could constrain whether the plan advances in 2026.
• What this means for business: If enacted, the Plan would have significant implications across the healthcare ecosystem. Pharmaceutical manufacturers could face renewed pricing pressure through MFN benchmarks, while also gaining potential opportunities through direct discounting arrangements and expanded over-the-counter sales. Health insurers could confront new transparency and reporting obligations that could affect competitive positioning, administrative costs, and public scrutiny of claims management practices. For employers, providers, and investors, the plan signals continued momentum toward consumer-directed healthcare financing, reduced reliance on intermediaries such as PBMs, and heightened expectations for upfront pricing and cost disclosure.
• The proposal is likely to shape reconciliation negotiations, regulatory priorities, and market expectations throughout 2026.