Chabria: Beneath the rambling, Trump laid out a chilling healthcare plan

President Trump offered only a sketchy outline of his healthcare plan during a nationally televised address Wednesday night.

(Doug Mills/The New York Times via AP, Pool)

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Dec. 18, 2025

3:15 PM PT

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Starting in January, premiums for too many people are going to leap skyward without the subsidies.

Trump tried to blame the expiring subsidies on Democrats.

Folks, who was supposed to be watching grandpa last night? Because he got out, got on TV and ... It. Was. Not. Good.

For 18 long minutes Wednesday evening, we were subjected to a rant by President Trump that predictably careened from immigrants (bad) to jobs (good), rarely slowing down for reality. But jumbled between the vitriol and venom was a vision of American healthcare that would have horror villainess M3GAN shaking in her Mary Janes — a vision that we all should be afraid of because it would take us back to a dark era when insurance couldn’t be counted on.

Trump’s remarks offered only a sketchy outline, per usual, in which the costs of health insurance premiums may be lower — but it will be because the coverage is terrible. Yes, you’ll save money. But so what? A cheap car without wheels is not a deal.

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“The money should go to the people,” Trump said of his sort-of plan.

The money he vaguely was alluding to is the government subsidies that make insurance under the Affordable Care Act affordable. After antics and a mini-rebellion by four Republicans also on Wednesday, Congress basically failed to do anything meaningful on healthcare — pretty much ensuring those subsidies will disappear with the New Year.

Starting in January, premiums for too many people are going to leap skyward without the subsidies, jumping by an average of $1,016 according to the health policy research group KFF.

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That’s bad enough. But Trump would like to make it worse.

The Affordable Care Act is about much more than those subsidies. Before it took effect in 2014, insurance companies in many states could deny coverage for preexisting conditions. This didn’t have to be big-ticket stuff like cancer. A kid with asthma? A mom with colitis? Those were the kind of routine but chronic problems that prevented millions from obtaining insurance — and therefore care.

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Obamacare required that policies sold on its exchange did not discriminate. In addition, the ACA required plans to limit out-of-pocket costs and end lifetime dollar caps, and provide a baseline of coverage that included essentials such as maternity care. Those standards put pressure on all plans to include more, even those offered through large employers.

Trump would like to undo much of that. He instead wants to fall back on the stunt he loves the most — send a check!

What he is suggesting by sending subsidy money directly to consumers also most likely would open the market to plans without the regulation of the ACA. So yes, small businesses or even groups of individuals might be able to band together to buy insurance, but there likely would be fewer rules about what — or whom — it has to cover.

Most people aren’t savvy or careful enough to understand the limitations of their insurance before it matters. So it has a $2-million lifetime cap? That sounds like a lot until your kid needs a treatment that eats through that in a couple of months. Then what?

Trump suggested people pay for it themselves, out of health savings accounts funded by that subsidy check sent directly to taxpayers. Because that definitely will work, and people won’t spend the money on groceries or rent, and what they do save certainly will cover any medical expenses.

“You’ll get much better healthcare at a much lower price,” Trump claimed Wednesday. “The only losers will be insurance companies that have gotten rich, and the Democrat Party, which is totally controlled by those same insurance companies. They will not be happy, but that’s OK with me because you, the people, are finally going to be getting great healthcare at a lower cost.”

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He then bizarrely tried to blame the expiring subsidies on Democrats.

Democrats “are demanding those increases and it’s their fault,” he said. “It is not the Republicans’ fault. It’s the Democrats’ fault. It’s the Unaffordable Care Act, and everybody knew it.”

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It seems like Trump just wants to lower costs at the expense of quality. Here’s where I take issue with the Democrats. I am not here to defend insurance companies or our healthcare system. Both clearly need reform.

But why are the Democrats failing to explain what “The money should go to the people” will mean?

I get that affordability is the message, and as someone who bought both a steak and a carton of milk this week, I understand just how powerful that issue is.

Still, everyone, Democrat or Republican, wants decent healthcare they can afford, and the peace of mind of knowing if something terrible happens, they will have access to help. There is no American who gladly would pay for insurance each month, no matter how low the premium, that is going to leave them without care when they or their loved ones need it most.

Grandpa Trump doesn’t have this worry, since he has the best healthcare our tax dollars can buy.

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But when he promises to send a check instead of providing governance and regulation of one of the most critical purchases in our lives, the message is sickening: My victory in exchange for your well-being.

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Ideas expressed in the piece

The author contends that President Trump’s healthcare vision prioritizes affordability over coverage quality, fundamentally undermining consumer protections established under the Affordable Care Act. The proposal to send subsidy money directly to consumers rather than maintaining regulatory frameworks would likely enable insurance plans without ACA requirements, exposing millions to the pre-2014 era when insurers could deny coverage based on preexisting conditions. The author argues that while direct payments might appear attractive, consumers lack the sophistication to identify coverage gaps before facing medical crises, and subsidies sent as checks could be redirected toward living expenses rather than insurance. Trump’s characterization of the plan as delivering better healthcare at lower prices represents a false choice, according to the author, as lower premiums achieved through reduced coverage standards would ultimately compromise access to care when individuals most need it. The author also criticizes the administration for failing to address expiring ACA subsidies, noting that premiums will increase by an average of $1,016 in January, and contends that Trump’s blame directed toward Democrats obscures Republican responsibility for the subsidies’ lapse. The author particularly emphasizes that replacing governance and regulation of healthcare with direct consumer payments reflects political victory prioritized over public well-being.

Different views on the topic

Proponents of the Trump administration’s healthcare approach argue that market-based reforms and expanded consumer choice will drive costs down while improving outcomes. The administration has pursued multiple cost-containment strategies, including most-favored-nation pricing to align U.S. drug costs with other developed nations and crackdowns on pharmacy benefit managers, positioning these measures as protecting patients from middlemen profiting from healthcare[1]. The Trump administration has announced pharmaceutical price deals with major manufacturers to bring prices in line with other developed nations, alongside expanded Health Savings Accounts and Direct Primary Care access, which proponents contend give Americans greater control over healthcare spending[2]. Supporters view expanded HSA eligibility for Bronze and Catastrophic plans as empowering individuals to make informed choices aligned with their circumstances[3]. Additionally, House Republicans have proposed allowing small businesses to offer their own health plans, framing this as increasing competition and options rather than reducing protections[4]. Some Republican moderates have engaged in ongoing negotiations to find compromise solutions on subsidies, suggesting that not all conservatives oppose maintaining some form of coverage support. Advocates for this approach argue that excessive regulation increases premiums and that giving money directly to consumers rather than intermediaries allows families to prioritize their own healthcare needs.

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