{"id":700694,"date":"2026-01-06T09:00:00","date_gmt":"2026-01-06T14:00:00","guid":{"rendered":""},"modified":"2026-01-06T09:59:59","modified_gmt":"2026-01-06T14:59:59","slug":"trump-has-no-health-plan-he-has-the-art-of-the-health-care-deal","status":"publish","type":"from-drew-altman","link":"https:\/\/www.kff.org\/from-drew-altman\/trump-has-no-health-plan-he-has-the-art-of-the-health-care-deal\/","title":{"rendered":"Trump Has No Health Plan, He Has the Art of the Health Care Deal"},"content":{"rendered":"<div\n\tclass=\"wp-block-kff-shared-content--standard-layout wp-block-kff-shared-content\">\n\t\n\n<section class=\"wp-block-kff-shared-content-main\">\n\t\t\t<div class=\"post-header\">\n\t\t\t\t\t\n\t<h1 class=\"post-header__title\">Trump Has No Health Plan, He Has the Art of the Health Care Deal<\/h1>\n\n\t\n\t\t\t<div class=\"post-header__meta\">\n\t\t\t\t\t<div>\n\t\t\t\t<span class=\"post-header__meta-label\">\n\t\t\t\tAuthor:\t\t\t\t<\/span>\n\t\t\t\t<a href=\"https:\/\/www.kff.org\/person\/drew-altman\/\">Drew Altman<\/a> \t\t\t<\/div>\n\t\t\t\t<div>\n\t\t\t<span class=\"post-header__meta-label\">Published:<\/span>\n\t\t\t<date>Jan 6, 2026<\/date>\n\t\t<\/div>\n\t\t<\/div>\n\t\n\t<div class=\"post-header__social-sharing\">\n\t\t<button class=\"post-header__social-sharing__button print\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M4.348 2.5v3.391H2.783A.787.787 0 0 0 2 6.674v4.696c0 .429.353.782.783.782h1.565V14.5h7.304v-2.348h1.565c.43 0 .783-.353.783-.782V6.674a.787.787 0 0 0-.783-.783h-1.565V2.5H4.348Zm.522.522h6.26v2.87H4.87v-2.87ZM2.783 6.413h1.782a.26.26 0 0 0 .085 0h6.697a.26.26 0 0 0 .086 0h1.784c.148 0 .261.114.261.26v4.697c0 .147-.113.26-.26.26h-1.566V9.283H4.348v2.347H2.783a.257.257 0 0 1-.261-.26V6.674c0-.147.113-.261.26-.261Zm9.39.783a.522.522 0 1 0 0 1.043.522.522 0 0 0 0-1.043ZM4.87 9.804h6.26v2.043a.264.264 0 0 0 0 .086v2.045H4.87v-2.043a.261.261 0 0 0 0-.085V9.804Zm1.043.783a.262.262 0 0 0-.265.26.26.26 0 0 0 .265.262h4.174a.26.26 0 1 0 0-.522H5.913Zm0 1.043a.26.26 0 1 0 0 .522h3.13a.26.26 0 1 0 0-.522h-3.13Zm0 1.044a.26.26 0 1 0 0 .522h4.174a.262.262 0 0 0 .264-.261.26.26 0 0 0-.264-.261H5.913Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tPrint\t\t<\/button>\n\t\t<a href=\"mailto:?subject=Trump%20Has%20No%20Health%20Plan%2C%20He%20Has%20the%20Art%20of%20the%20Health%20Care%20Deal&#038;body=https%3A%2F%2Fwww.kff.org%2Ffrom-drew-altman%2Ftrump-has-no-health-plan-he-has-the-art-of-the-health-care-deal%2F\" class=\"post-header__social-sharing__button\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M2.333 4.25h-.25v9.14h12.5V4.25H2.333Zm1.083 1.693-.353-.2V5.23h10.54v.513l-.353.2L8.333 8.73 3.416 5.943Zm-.353 6.467V6.884l.107.06 5.04 2.857.123.07.123-.07 5.04-2.857.107-.06v5.526H3.063Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tEmail\t\t<\/a>\n\t\t<button class=\"post-header__social-sharing__button copy\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M11.533 2.9c-.615 0-1.23.235-1.697.702L8.502 4.936a2.4 2.4 0 0 0-.575 2.46l.958-.958a1.32 1.32 0 0 1 .371-.748l1.334-1.333a1.331 1.331 0 0 1 1.886 0c.52.52.52 1.365 0 1.885l-1.334 1.333c-.21.21-.474.331-.748.372l-.958.958a2.393 2.393 0 0 0 2.46-.576l1.334-1.333a2.402 2.402 0 0 0 0-3.394 2.393 2.393 0 0 0-1.697-.702Zm-1.61 3.46a.533.533 0 0 0-.367.162l-3.2 3.2a.533.533 0 1 0 .754.754l3.2-3.2a.534.534 0 0 0-.387-.915ZM6.586 7.973a2.388 2.388 0 0 0-1.816.697l-1.334 1.333a2.403 2.403 0 0 0 0 3.394 2.393 2.393 0 0 0 1.697.702c.614 0 1.229-.234 1.697-.702l1.333-1.334a2.4 2.4 0 0 0 .576-2.46l-.959.958a1.32 1.32 0 0 1-.37.749l-1.334 1.333a1.334 1.334 0 0 1-1.886-1.885l1.334-1.334c.21-.21.474-.331.748-.372l.958-.957c-.21-.07-.426-.11-.644-.122Z\" fill=\"#004B88\"\/>\n\t\t\t<\/svg>\n\n\t\t\t<span>Copy Link<\/span>\n\t\t<\/button>\n\t\t\t<\/div>\n\t<\/div>\n\t\t\t\n\n<p class=\"wp-block-paragraph\">President Trump is often derided for not having a health reform plan, or even his \u201cconcepts of a plan\u201d he\u2019s talked about, or more narrowly, a plan to replace the ACA and its enhanced tax credits currently under debate. It\u2019s true he has none of these. But he does have a distinctive game plan of sorts that\u2019s unlike anything we\u2019ve seen before: a series of one-off deals with the health care industry. Most rely on presidential jawboning and voluntary action by industry groups. Some have the threat of regulatory action to go along with hard-edged presidential persuasion. They have the character more of real estate deals than \u201cplans.\u201d Or they\u2019re more similar to Trump\u2019s approach to some of what he calls his foreign policy \u201cdeals\u201d (like the current attempt at a peace deal in Ukraine). Or his tariff deals that come and go. To use a word commonly associated with Trump, it\u2019s health policy by transaction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The plans are far from comprehensive health reform plans addressing&nbsp;coverage and costs and they don\u2019t change the long-term profit incentives of the health care companies that participate in the deals. They in no way offset the huge cuts in Medicaid and the ACA made on his watch. Still, they signify action to voters on issues they care about, can capture news cycles, and even do some good, like lowering some drug prices, at least temporarily. The benefits of some of the deals are exaggerated as Trump is wont to do.&nbsp;A big question about them is whether they have staying power.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There have been three major deals so far, and Trump has started to talk up a fourth deal that, at first blush, sounds bigger than all the others combined.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trump\u2019s first big set of deals was with the drug companies. It began with deals with three, then eventually nine, drug companies to lower prices on drugs provided to Medicaid beneficiaries, characterized as part of a voluntary \u201cmost favored nation\u201d (MFN) policy aligning prices with those paid by other wealthy nations, in return for reported tariff relief. (Whether these deals actually lower costs for Medicaid programs below the rebates they currently get is not my focus here.) Trump also made deals with Eli Lilly and Novo Nordisk to cut GLP-1 prices voluntarily for some patients and to sell the drugs to others on TrumpRx. The Center for Medicare and Medicaid Innovation will test out models for MFN targets,\u00a0and regulations have now been promulgated to codify the MFN policy, potentially giving it staying power, at least for some drug prices. For a discussion, see our <a href=\"https:\/\/www.kff.org\/event\/developments-in-prescription-drug-pricing-under-the-second-trump-administration\/\">Wonk Shop<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The administration also announced a voluntary effort with big health insurance companies to speed up <a href=\"https:\/\/www.hhs.gov\/press-room\/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html\">and simplify prior authorization review<\/a>, including promised reforms to cut back on what is reviewed and how often. The effort is expected to kick in this year, though follow through by the companies is TBD and merits scrutiny. The public is beyond frustrated with <a href=\"https:\/\/www.kff.org\/from-drew-altman\/why-we-are-stuck-with-prior-authorization-review\/\">prior authorization review<\/a>, as are physicians, but only 20% of the public was <a href=\"https:\/\/www.kff.org\/patient-consumer-protections\/kff-health-tracking-poll-public-finds-prior-authorization-process-difficult-to-manage\/\">aware<\/a> of the announcement when it was made in June, and few had much faith that it would produce results. Somewhat incongruously, at the same time as they were cutting back on prior authorization review, the administration also announced a demonstration project to introduce targeted prior authorization review to traditional <a href=\"https:\/\/thehill.com\/policy\/healthcare\/5446697-house-democrats-question-hhs-prior\/\">Medicare<\/a> for the first time, focusing on procedures it sees as prone to fraud and abuse.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Another Trump voluntary initiative led by CMS is a partnership with more than 60 providers, payers and software companies to improve <a href=\"https:\/\/www.kff.org\/patient-consumer-protections\/charting-the-way-forward-new-efforts-to-advance-electronic-health-information-sharing\/\">electronic patient information sharing<\/a> and give consumers better digital tools to use to navigate the health system and public programs. The partnership would require that some companies commit to inter-operability but generally presents participating companies with more new opportunities to make money than sacrifices.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And just before the holidays, in what would be by far the most ambitious deal yet, the president turned to what sounded like a fourth deal in the works, talking the health insurance industry into lowering their premiums.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trump\u2019s characterization of what might happen was grandiose: <\/p>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\" style=\"margin-right:var(--wp--preset--spacing--d-2-5);margin-left:var(--wp--preset--spacing--d-2-5)\">\u201cWe should have a meeting, and we should talk to them because I would say that maybe with one talk, they would be willing to cut their prices by 50, 60, or 70%. They&#8217;ve made a fortune.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trump\u2019s rhetoric is often exaggerated, and it&#8217;s possible he was mixing up profits and prices in his remarks or even that this deal will not materialize. Still,&nbsp;he said what he said, and cuts of that magnitude are fanciful. However inflated the premiums charged by health insurance companies may be, they do reflect the underlying costs of hospitals, outpatient care, drugs and the entire health system, and cannot simply be cut in half.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The would-be insurance company initiative is illustrative of the \u201cmake a deal\u201d approach: jawbone, negotiate in some fashion, make a deal, keep it simple and understandable to voters, and announce it with fanfare and usually lots of exaggeration, with no broader plan and without addressing the underlying causes of the problem. Still, any concessions made by the insurance industry would be a political win for Trump, garner news coverage, and at least appear to address voter concerns about affordability in a tangible way. It could also be argued that Trump\u2019s deals, however limited and exaggerated&nbsp;they may be, are disruptive in a positive way. Trump\u2019s drug deals, for example, have helped move the drug industry from politically untouchable to fair game. Similarly, his policies towards Russia and Europe are reprehensible to many but have resulted in Europe coming together and increasing defense spending in response.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There\u2019s an infamous example of a voluntary effort to restrain costs in health care under threat of government action that taught us a lot. It happened in the late 1970s and was called the Voluntary Effort. The shorthand was the \u201cVE.\u201d&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">President Jimmy Carter and then Health, Welfare, and Education Secretary Joesph Califano put together what was probably the most aggressive cost containment plan ever in health care,&nbsp;featuring a cap on hospital revenue growth. (Bill Clinton had an aggressive one as well, proposing to cap increases in insurance premiums). Carter\u2019s plan failed partly when the industry, led by virtually every major industry group, promised a voluntary effort to restrain hospital expenditure growth by 2 percentage points below 1977 rates. Growth rates were so high then (partly due to high inflation) that the target rates for 1978 and 1979 were 13.6% and 11.6%, respectively, which is hard to fathom now as we complain mightily about much smaller increases. As I captured in our <a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.W2.83\">Sad History of Health Care Cost Containment As Told in One Chart<\/a> article years ago, a Health Affairs article I wrote with Larry Levitt, the impact of the VE was short lived, but Carter\u2019s cost plan died in Congress in 1979, partly due to the VE.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trump\u2019s VEs are a little different. They are not industry efforts to ward off government action so much as deals initiated by President Trump to achieve short term gains (arguably in some cases) and create at least the appearance of progress on the issue of the day\u2014affordability\u2014and of action on \u201chealth reform.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the larger picture, by no accounting can the benefits of these one-off deals offset the combined impact on the public of the nearly trillion dollars in Medicaid cuts that will kick in over the next 10 years and the premium spikes that will hit Marketplace enrollees if the enhanced tax credits are not extended, as now seems inevitable. I doubt President Trump connects these dots. His approach isn\u2019t about a policy direction he\u2019s pursuing, or a health reform plan, or a bigger picture\u2014it\u2019s a series of deals. There are likely more to come.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.kff.org\/perspectives\/beyond-the-data\/\">View all of Drew\u2019s Beyond the Data Columns<\/a><\/p>\n\n\t<div class=\"post-footer\">\n\t<div class=\"post-footer__title\">More On<\/div>\n\t<div class=\"post-footer__links\">\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/affordable-care-act\/\">\n\t\t\t\tAffordable Care Act\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/health-costs\/\">\n\t\t\t\tHealth Costs\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/medicaid\/\">\n\t\t\t\tMedicaid\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/aca-marketplaces\/\">\n\t\t\t\tACA Marketplaces\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/health-i-t\/\">\n\t\t\t\tHealth I.T.\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/premiums\/\">\n\t\t\t\tPremiums\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/prescription-drugs\/\">\n\t\t\t\tPrescription Drugs\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/prior-authorization\/\">\n\t\t\t\tPrior Authorization\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/subsidies\/\">\n\t\t\t\tSubsidies\t\t\t<\/a>\n\t\t\t<\/div>\n<\/div>\n\t<\/section>\n\n\n<section class=\"wp-block-kff-shared-content-sidebar\">\n\t\t\t\n\t\t\n<div class=\"wp-block-kff-shared-related-content--green wp-block-kff-shared-related-content\">\n\t<h2 class=\"wp-block-kff-shared-related-content__heading\">Related Content<\/h2>\n\t<div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/from-drew-altman\/health-policy-in-2026\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tFrom Drew Altman: Health Policy in 2026\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/from-drew-altman\/why-we-are-stuck-with-prior-authorization-review\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tFrom Drew Altman: Why We Are Stuck with Prior Authorization Review\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/event\/developments-in-prescription-drug-pricing-under-the-second-trump-administration\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tThe Health Wonk Shop: Developments in Prescription Drug Pricing under the Second Trump Administration\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\t\t\t<\/section>\n\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump\u2019s \u201cmake a deal\u201d approach to health care. He explains that while the president doesn\u2019t have a health reform plan, or even \u201cconcepts of a plan,\u201d or a replacement for the ACA, he does have a distinctive set of tactics that features one-off deals with the health care industry that are more like \u201chealth policy by transaction.\u201d He writes that the deals \u201ceven do some good,\u201d but \u201cdon\u2019t change the long-term incentives of the health care companies that participate in the deals,\u201d and a big question is \u201cwhether they have staying power.\u201d<\/p>\n","protected":false},"author":155412884,"featured_media":700746,"template":"","meta":{"authors":[{"type":"foundation","id":49507,"name":"","_id":"bf7b60d4-05c3-409d-b8a0-9dbc8a4e235d"}],"exhibits":[],"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","search_keywords":"10915","shortlink":"","footnotes":""},"categories":[3962798,1274092,140023],"tags":[954238,142169984,301221,69739,579145436,86400],"content-types":[579145480],"series":[579145466],"program":[],"partner":[],"class_list":["post-700694","from-drew-altman","type-from-drew-altman","status-publish","has-post-thumbnail","hentry","category-affordable-care-act","category-health-costs","category-medicaid","tag-aca-marketplaces","tag-health-i-t","tag-premiums","tag-prescription-drugs","tag-prior-authorization","tag-subsidies","content-types-from-drew-altman","series-beyond-the-data"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.9 (Yoast SEO v25.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Trump Has No Health Plan, He Has the Art of the Health Care Deal | KFF<\/title>\n<meta name=\"description\" content=\"In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump\u2019s \u201cmake a deal\u201d approach to health care. He explains that while the president doesn\u2019t have a health reform plan, or even \u201cconcepts of a plan,\u201d or a replacement for the ACA, he does have a distinctive set of tactics that features one-off deals with the health care industry that are more like \u201chealth policy by transaction.\u201d He writes that the deals \u201ceven do some good,\u201d but \u201cdon\u2019t change the long-term incentives of the health care companies that participate in the deals,\u201d and a big question is \u201cwhether they have staying power.\u201d\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.kff.org\/from-drew-altman\/trump-has-no-health-plan-he-has-the-art-of-the-health-care-deal\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trump Has No Health Plan, He Has the Art of the Health Care Deal\" \/>\n<meta property=\"og:description\" content=\"In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump\u2019s \u201cmake a deal\u201d approach to health care. 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