• President Donald Trump renewed calls for Republicans to stop sending federal healthcare dollars to insurance companies
• The December 31 Truth Social post came one day before enhanced Affordable Care Act subsidies expired
• Approximately 22 million Americans face premium increases averaging 114% annually according to Kaiser Family Foundation

WASHINGTON (TDR) — President Donald Trump on Wednesday renewed his call for Republicans to stop sending federal healthcare dollars to insurance companies, instead directing the money to individuals as millions of Americans face sharply higher premiums following the expiration of enhanced Affordable Care Act subsidies. The Truth Social post came one day before the subsidies expired on January 1, 2026, leaving approximately 22 million Americans facing massive cost increases.

Trump Targets Insurance Industry

Trump wrote on Truth Social that Republicans should send no more money to “Fat Cat Insurance Companies,” demanding instead that funds go directly to people to purchase their own healthcare. The December 31 message echoed previous statements the president made during negotiations over government shutdown and subsidy extensions.

“Republicans: No more money to Fat Cat Insurance Companies. The money must go directly to the people to buy their own Healthcare.”

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The president’s proposal lacks specific implementation details, leaving uncertainty about how Americans would navigate healthcare markets without traditional insurance company structures. Health policy experts note that ACA subsidies currently flow directly to insurers to offset monthly premiums, never reaching consumers as direct payments.

Massive Premium Increases Hit Millions

The Kaiser Family Foundation estimates annual out-of-pocket premium payments for subsidized enrollees will increase by an average of 114%, though individual impacts vary widely depending on income, state, and other factors. More than 90% of the 24 million ACA marketplace enrollees currently receive enhanced premium tax credits to lower monthly costs.

Individual families report dramatic cost spikes. A Point Pleasant, New Jersey couple told CNN their plan’s premium will skyrocket to $1,928 monthly from $340 this year, forcing them to become uninsured. A Vermont couple faces premiums jumping to nearly $2,670 monthly from $625, making coverage unaffordable for their small garage door business.

The Congressional Budget Office projected that gross benchmark premiums could increase by 4.3% in 2026 and 7.7% in 2027 for marketplace plans. An Urban Institute and Commonwealth Fund analysis predicted approximately 4.8 million Americans will drop coverage in 2026 due to unaffordable premium increases.

Congressional Gridlock Over Extension

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Congress failed to extend the subsidies before their December 31 expiration despite months of contentious negotiations. The issue became a central sticking point during the longest government shutdown in U.S. history in October and November, with Democrats demanding subsidy extensions as part of any deal to reopen the government.

Senate Democratic Leader Chuck Schumer blamed Republican obstruction and inaction for what he described as a healthcare crisis. Democrats insisted on extending premium tax credits as part of spending bills, warning their expiration would prove detrimental for millions of American families.

Republicans argued the pandemic-era expansions went too far and attempted to fund temporary spending bills without addressing expiring subsidies, promising to discuss continuation later. In early November, the Senate reached a bipartisan deal to end the shutdown that did not include Democratic demands on healthcare subsidies.

Direct Payment Proposal Details Unclear

Trump’s proposal to send healthcare money directly to Americans lacks concrete implementation mechanisms. Senator Rick Scott of Florida previously announced he was “writing the bill right now” in response to similar Trump statements in November, but no detailed legislation has emerged.

Senator Bill Cassidy of Louisiana, chair of the Senate health committee, proposed redirecting ACA tax credit money into pre-funded federal flexible spending accounts. Other Republicans suggested using health savings accounts to help consumers pay out-of-pocket expenses.

Critics question how Americans would navigate complex healthcare markets without insurance company infrastructure. Senator Chris Murphy of Connecticut called Trump’s suggestion “nonsensical,” asking whether the president proposed eliminating health insurance and giving people a few thousand dollars that would leave them bankrupt after a cancer diagnosis.

Health Experts Dispute Trump Claims

Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, directly contradicted Trump’s characterization of subsidy recipients. She stated the money was never going to the health insurance industry but rather to individuals as financial assistance through the tax code.

The enhanced subsidies were first provided to Affordable Care Act enrollees in 2021 as a temporary measure to help Americans through the COVID-19 pandemic. Democrats extended them, moving the expiration date to January 1, 2026. With expanded subsidies, some lower-income enrollees received healthcare with no premiums, and high earners paid no more than 8.5% of their income.

Trump stated last week he wants to meet with health insurance companies about cutting rates. The Blue Cross Blue Shield Association responded that they are eager to drive solutions with Trump and Congress that bring down healthcare costs.

Impact on Small Businesses and Self-Employed

The subsidy expiration particularly affects small business owners, self-employed workers, farmers, and ranchers who purchase insurance through marketplace exchanges rather than receiving employer-sponsored coverage. Nearly half of adults in the individual health insurance market are self-employed or own or work at small businesses.

A Salt Lake City freelance filmmaker and adjunct professor absorbed the extra expense despite financial strain. A New York City freelance musician who previously paid no premium discovered his cheapest 2026 plan would cost $275 monthly, leading him to become uninsured since he cannot afford coverage.

Florida faces the greatest potential impact as the state with the largest number of ACA enrollees—more than 4.7 million according to KFF data. Health analysts predict expiration will drive younger and healthier Americans to forgo coverage, making the program more expensive for the older, sicker population that remains.

State Emergency Responses

Several states including California and Colorado approved temporary measures to provide emergency health insurance aid as federal subsidies lapsed. State governments are attempting to cushion the impact for residents facing dramatic premium increases.

The timing comes at the start of a high-stakes midterm election year with affordability including healthcare costs topping voters’ concerns. Open enrollment for marketplace plans continues until January 15 in most states, giving Americans limited time to select coverage despite uncertainty about subsidy restoration.

Potential January House Vote

Four House Republicans including three from Pennsylvania sided with Democrats in December to force a vote on a Democratic bill extending ACA subsidies for three years. The vote will not occur until January, after subsidies already expired, with success far from guaranteed given Republican opposition.

Some lawmakers suggest subsidies could be retroactively applied to January 1 if Congress reaches agreement, potentially allowing a new enrollment period for people who dropped coverage due to cost. However, the political will to extend subsidies remains unclear with Republicans controlling both chambers of Congress.

Should the federal government send healthcare dollars directly to individuals as Trump proposes, or do insurance companies serve necessary functions in managing risk pools and negotiating provider rates?

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