President Trump’s Healthcare Philosophy: Less Government, More Choices

President Donald Trump is building on actions from his first term that aimed to increase competition and affordability in healthcare through alternative coverage options, focusing on market-based reforms, deregulation, and consumer empowerment—not expanding government subsidies or huge new regulatory schemes like Obamacare. The Trump Administration is providing regulatory relief by making permanent and universal certain exemptions from Affordable Care Act (ACA) regulations, growing the market and giving patients more options instead of expanding government power and subsidies.

During his first term, President Trump accomplished several key market-based reforms including:

• Expanding access to Association Health Plans (AHPs), which allow small businesses, industries, or collective groups to band together for coverage, often at lower costs. Example: farm-bureau style health plans.
• Opening up short-term limited-duration insurance plans (STLDI), which are exempt from many ACA mandates and can often offer cheaper premiums.
• Allowing and promoting Individual Coverage Health Reimbursement Arrangements (ICHRAs), which let employers of any size offer tax-free money to employees to purchase their own health insurance, giving the employees more control over their care.
• Requiring more price transparency. The President’s efforts to bring more transparency to hospital pricing, in particular, is a key step in de-mystifying health care costs — and one of ALEC’s Essential Policy Solutions for 2026.

The Trump administration has made it clear it doesn’t favor bills that simply renew existing policies and subsidies that fail to address root causes (often excessive regulation) that drive up costs. Instead, it has prioritized allowing patients to control their own resources rather than funneling money through government programs and subsidies.

So, what is next on the Trump Administration’s healthcare agenda? Given President Trump’s comments on Truth Social, here are a few things to look for:

• Maximum price transparency: Transparency shouldn’t stop at hospitals! Requiring insurers and other healthcare providers to disclose actual prices will allow consumers to actually shop for their healthcare, bringing more competition to the healthcare market, will lower costs.
• Making STLDIs and other Obamacare-exempt plans permanent options: The Congressional Budget Office found that President Trump’s 2018 rule change that enhanced STLDIs by expanding their time limit to thirty-six months made comprehensive coverage available at premiums 60 percent below those of the cheapest Obamacare plans, and that those plans often had wider provider networks. Kentucky Rep. Vanessa Grossl has already introduced legislation to allow Kentucky residents to purchase Obamacare-exempt plans available in U.S. territories.
• Shifting subsidies from the government to the individual: According to Cato’s Michael Cannon, the United States government controls 84 percent of healthcare spending—one of the highest of all advanced nations. The answer: let consumers control the money. For example, making funds go directly to an individual tax-free universal health account.
• Lowering prescription drug prices by eliminating costly middlemen, known as pharmacy benefit managers (PBMs), and allowing direct to consumer sales.

None of these actions requires major structural changes to Medicare, Medicaid, or employer-sponsored health insurance. Instead, they prioritize competition, individual choice, and reduced bureaucratic barriers to make coverage more affordable without relying on government subsidies. President Trump’s healthcare legacy may be his consistent philosophy: reduce federal overreach and help Americans frustrated with rising healthcare costs by unleashing market forces through real price transparency and more options.