{"id":701446,"date":"2026-01-16T08:13:57","date_gmt":"2026-01-16T13:13:57","guid":{"rendered":"https:\/\/www.kff.org\/?post_type=quick-take&p=701446"},"modified":"2026-01-16T08:18:12","modified_gmt":"2026-01-16T13:18:12","slug":"the-great-healthcare-plan-leaves-open-questions-for-people-with-pre-existing-conditions","status":"publish","type":"quick-take","link":"https:\/\/www.kff.org\/quick-take\/the-great-healthcare-plan-leaves-open-questions-for-people-with-pre-existing-conditions\/","title":{"rendered":"The \u2018Great Healthcare Plan\u2019 Leaves Open Questions for People with Pre-existing Conditions"},"content":{"rendered":"\n

In a video message<\/a> and one-page fact sheet<\/a>, President Trump announced a health care framework aimed at lowering costs and \u201cholding big insurance companies accountable.\u201d<\/p>\n\n\n\n

Some provisions look very similar to ones that are already in the Affordable Care Act (ACA). For example, the ACA as implemented, includes public data on claims denials and insurer overhead, and \u201cplain-English\u201d insurance coverage summaries. Additionally, the first Trump administration used ACA authority to require hospitals and insurers to reveal prices.<\/p>\n\n\n\n

Additionally, the Obama administration had made payments to insurers for cost-sharing reductions, but in Trump\u2019s first administration, those payments were halted. The \u201cGreat Healthcare Plan\u201d appears to be a 180, proposing to reinstate the payments to insurers. (Another post explains<\/a> how this could leave many ACA enrollees paying more, not less.)<\/p>\n\n\n\n

Other provisions of the president\u2019s health care framework, though, sound like a radical departure from the Affordable Care Act. It\u2019s not entirely clear from the summary exactly what is meant by the proposal to \u201csend the money directly to the American people.\u201d The fact sheet says it would allow Americans to use the \u201cextra\u201d taxpayer-funded subsidies to \u201cbuy the health insurance of their choice.\u201d In recent months, Congressional Republicans have proposed a few policies that would expand or fund Health Savings Accounts (HSAs), but those proposals vary significantly from each other<\/a>.<\/p>\n\n\n\n

For example, a proposal by Senator Scott would allow states to seek a waiver that would allow all the ACA\u2019s tax credit dollars to be used for non-ACA compliant coverage that sets higher premiums for people with pre-existing conditions. If, as expected, healthier people choose medically underwritten plans, those left in the Marketplaces would be sicker. That would likely lead to a \u201cdeath spiral\u201d in the ACA markets in states that took up that waiver, potentially leaving many people with pre-existing conditions without any option for health coverage. A very different HSA proposal by Senator Cassidy would have directed only the \u201cenhanced\u201d portion of the ACA\u2019s premium tax credits to HSAs, which would have only been available to ACA Marketplace enrollees. The Cassidy plan likely would not pose the same risks of ACA market instability as the Scott plan.  <\/p>\n\n\n\n

The president\u2019s plan is vague and, without knowing more, it is impossible to say what the implications would be for people with pre-existing conditions who rely on the ACA markets. The framework does not explicitly say people with pre-existing conditions are protected. The short description leaves open key questions, including:<\/p>\n\n\n\n

    \n
  1. Is it only the enhanced premium tax credit dollars that would be converted to a savings account, or are other taxpayer subsidies included in the \u201cextra\u201d?<\/li>\n\n\n\n
  2. Who is eligible for this financial help and how would it be calculated and dispersed? Who will end up paying more and who will pay less?<\/li>\n\n\n\n
  3. Would the funds be limited to out-of-pocket costs only or be used for premiums?<\/li>\n\n\n\n
  4. Would any savings account money be in addition to or in lieu of premium tax credits, and would enrollees have a choice?<\/li>\n\n\n\n
  5. Would this new financial support be available only on the ACA Marketplaces or could it be used to purchase health insurance that discriminates against people with pre-existing conditions, potentially leading to instability in the ACA Marketplace?<\/li>\n<\/ol>\n\n\n\n

    Until the \u201cGreat Healthcare Plan\u201d takes shape and details are filled in, it leaves open questions about out-of-pocket costs, premiums, federal spending, and health coverage for people with pre-existing conditions.<\/p>\n","protected":false},"excerpt":{"rendered":"

    President Trump announced a health care framework that leaves open key questions, including those about out-of-pocket costs, premiums, federal spending, and health coverage for people with pre-existing conditions.<\/p>\n","protected":false},"author":48664038,"featured_media":701449,"template":"","meta":{"authors":[{"type":"foundation","id":49499,"name":"","_id":"65be3ba1-5892-4d59-b1c3-041753f5f74e"}],"exhibits":[],"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","search_keywords":"Affordable Care Act","footnotes":""},"categories":[],"tags":[954238,579145440,2096708,4517],"content-types":[579145484],"program":[],"series":[],"class_list":["post-701446","quick-take","type-quick-take","status-publish","has-post-thumbnail","hentry","tag-aca-marketplaces","tag-health-care-markets","tag-pre-existing-conditions","tag-taxes","content-types-quick-take"],"yoast_head":"\nThe \u2018Great Healthcare Plan\u2019 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