President Donald Trump has intensified his attacks on private health insurers that receive public money through the Affordable Care Act, declaring that he will only support a plan that sends federal healthcare funds straight to individual Americans. His recent Truth Social posts portray insurance companies as powerful corporations that have enriched themselves at the public’s expense. Trump wrote that he opposes any plan that would direct money to what he called the “BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH.”
The policy he endorsed, promoted by Senate Republicans including Sen. Bill Cassidy and supported by Sen. Rick Scott, would eliminate ACA subsidies and convert them into direct federal payments that individuals could use to buy private health insurance. Trump has described this as the only approach he is willing to approve. In one post, he said, “THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH. THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE!”
He urged Congress to move quickly, telling lawmakers, “Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!! GET IT DONE, NOW.”
Trump reiterated this position in earlier posts from Nov. 8. One stated, “I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over.” Another said, “In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare.”
A third post added, “NO MORE MONEY, HUNDREDS OF BILLIONS OF DOLLARS, TO THE DEMOCRAT SUPPORTED INSURANCE COMPANIES FOR REALLY BAD OBAMACARE. THE MONEY MUST NOW GO DIRECTLY TO THE PEOPLE, TAKING THE ‘FAT CAT’ INSURANCE COMPANIES OUT OF THE CORRUPT SYSTEM OF HEALTHCARE. THE PEOPLE CAN BUY THEIR OWN, MUCH BETTER POLICY, FOR MUCH LESS MONEY, SAVING, FOR THEMSELVES, AN ABSOLUTE FORTUNE!!!”
Sen. Rick Scott responded by signaling full support. “Totally agree, @POTUS! I’m writing the bill right now. We must stop taxpayer money from going to insurance companies and instead give it directly to Americans in HSA-style accounts and let them buy the health care they want. This will increase competition & drive down costs.”
Sen. Bill Cassidy appeared on “Face the Nation” and said he is working closely with the Trump White House to put “meat on the bone” of the plan.
Administration officials have echoed this message. Dr. Mehmet Oz, Administrator for the Centers for Medicare & Medicaid Services, defended the approach by saying, “If you had a check in the mail, you could buy the insurance you thought was best for you.”
The proposal has drawn sharp criticism from health policy experts and progressive lawmakers who warn that it would dismantle the most significant financial supports available to millions of Americans while preserving the central role of private insurers. Trump has been “openly railing against the insurance companies that benefit from federal subsidies” under the ACA, yet the structure of the new proposal would still require Americans to purchase coverage from the same private companies. Instead of subsidizing specific plans, the government would send cash payments that could only be used to purchase insurance, with no requirement that insurers lower costs or improve coverage.
Democrats have warned that this shift, combined with steep reductions to Medicaid, would trigger widespread losses in coverage. The cuts are described as “the largest in the program’s history.” Analysts say that ending ACA subsidies could cause premiums to “double or more for over 20 million people in the coming year,” creating what some lawmakers call “a healthcare crisis in 2026 like nothing the nation has ever seen.”
Single-payer advocates have argued that Trump’s criticism of insurers strengthens the case for Medicare for All. Dr. Abdul El-Sayed responded to Trump’s attacks on the industry by saying, “Just wait until we tell you about Medicare for All.”
Melanie D’Arrigo, executive director of the Campaign for New York Health, warned that Trump’s plan would cause severe harm. “Trump’s ‘healthcare’ plan will bankrupt and kill millions of Americans,” she said. She contrasted the proposal with universal coverage, stating, “We can eliminate the private insurance industry, and save $650 billion per year with Medicare for All, which would cover everyone, save families money, and include dental, vision, prescriptions, and long-term care.” She repeated the figure a second time, saying, “We can eliminate the private insurance industry, and save $650 billion per year with Medicare for All.”
Warren Gunnels, a senior advisor to Sen. Bernie Sanders, emphasized the financial and medical risks created by a voucher-style system. “If we had Medicare for All, everyone would have healthcare with no premiums, deductibles, or co-payments, and we’d save $650 billion and 68,000 lives a year,” he said. He illustrated the limitations of direct payments under the Trump plan by adding, “If we gave cancer patients, at most, a check for $6,500 for a $150,000 treatment, they’d go bankrupt and die an early death.”
The structure of the Cassidy Trump proposal limits federal support to the purchase of private plans, many of which have high deductibles, restricted networks, and substantial out of pocket costs. Critics argue that the proposal transfers risk onto patients while allowing insurers to continue setting prices and coverage terms. The plan contains no mechanism to reduce medical costs, no guarantee that premiums would fall, and no requirements for insurers to expand benefits.
For low income families, disabled individuals, and people with chronic illnesses, the combined effects of reduced Medicaid coverage and the end of ACA subsidies could lead to large increases in medical debt and reduced access to essential care. Hospitals and safety net providers warn that millions of people could lose coverage or become underinsured, forcing more people to rely on emergency rooms and crisis care.
As the political debate intensifies, Medicare for All supporters note that Trump’s attacks on private insurers mirror public frustration with high premiums and deductibles but stop short of proposing a system that removes insurers from basic coverage altogether. Under Medicare for All proposals backed by Sanders and other Democrats, medically necessary care would be covered without premiums, deductibles, or co-payments. Under the Trump plan, the federal government would continue to fund private plans indirectly through individual payments, leaving insurers at the center of the healthcare system.
While Congress has not yet acted on the new proposal, the policy outlines released so far indicate a dramatic reshaping of federal healthcare spending. The months ahead will determine whether lawmakers pursue the direct payment model, maintain the current structure of ACA subsidies and Medicaid expansion, or revive broader conversations around universal public coverage. The warnings from advocates signal that the stakes are high for millions of Americans as the country moves closer to a possible 2026 coverage crisis.
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