Trump Says He'll Only Back Direct Health Care Payment Legislation

In a post on Truth Social, the president took a harder stance against health care companies and the Affordable Care Act.

President Donald Trump in the Oval Office of the White House on Nov. 10, 2025. Anna Moneymaker/Getty Images

President Donald Trump said on Nov. 18 that he would only approve legislation that provides direct health care payments to Americans amid looming congressional discussions over extending insurance subsidies that are set to expire.

“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,” Trump wrote in an all-caps post on Truth Social.

The president added that under the plan, Americans would be able to negotiate and purchase insurance before sending a message to members of Congress. He didn’t provide further details about how it might work.

“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,” he wrote in the post.

The government shutdown that ended last week was, in part, caused by a disagreement over health care policy.

Democrats wanted to include an extension of COVID-19 pandemic-era health care subsidies, set to expire at the end of the year, in a stopgap measure to reopen the government. Republicans said it was a separate policy matter to be addressed at another time.

Trump told reporters over the weekend that he had “personal talks with some Democrats” over how to deal with health care. Days before that, the president spoke to Fox News in an interview where he included a suggestion about the direct payment plan.

“People love it,” he told reporters at the time. “The insurance companies are making a fortune. Their stock is up over 1,000 percent over a short period of time. They are taking in hundreds of billions of dollars, and they’re not really putting it back, certainly not like they should.”

When asked about the idea during the Fox interview, Trump said that the money would “go into an account for people where the people buy their own health insurance,” which he said would cost less.

The president also criticized the Affordable Care Act (ACA), known as Obamacare, by saying that health care premiums have increased dramatically in recent years.

Administrator for the Centers for Medicare & Medicaid Services Mehmet Oz speaks during an event in the Oval Office of the White House on Oct. 16, 2025. Kevin Dietsch/Getty Images

Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, told CNN during a Nov. 16 interview that the White House had held internal discussions about extending the subsidies or replacing them. He said that there is “widespread fraud” in the ACA system that also needs to be addressed.

Sen. Bill Cassidy (R-La.) last week pitched a similar plan while speaking on the Senate floor that would send direct payments to Americans for health care insurance.

A permanent extension of the health care subsidies, which were previously extended in the 2022 Inflation Reduction Act, would increase the deficit by $350 billion from 2026 to 2035, while the number of people with health insurance would increase by 3.8 million in 2035, according to a September analysis by the Congressional Budget Office.

Before the shutdown ended last week, House Speaker Mike Johnson (R-La.) told a press conference that the tax credits are subsidizing bad policy.

Republicans “have a long list of ideas” to address health care costs, he said, and are “grabbing the best ideas that we’ve had for years to put it on paper and make it work.”

“We believe in the private sector and the free market and individual providers,” he added.

The Associated Press contributed to this report.