Diverging Paths on Health Care Affordability: Inside the White House and Congressional GOP Plans

Last week, a group of congressional Republicans and the White House released competing health care frameworks that outline different visions for advancing their respective policy priorities. Still, as the 2026 midterm elections loom, one theme unites the messaging: a focus on affordability.

While Congress and the Trump administration have multiple pathways to advance their health care priorities, in the months ahead, Republicans will remain focused on pursuing legislation—and potentially further rulemaking—centered on health care affordability across a wide range of industries, particularly pharmaceuticals and insurance.

Republican Study Committee “Reconciliation 2.0 Framework”

The Republican Study Committee (RSC) released “Making the American Dream Affordable Again,” a roadmap for a potential second Republican-only budget reconciliation bill that takes a direct aim at affordability. Outside of health care, the plan also provides policies on homeownership, energy prices and family care, building on the reforms included in the One Big Beautiful Bill Act (OBBBA) and continuing to work to eliminate wasteful government spending. In total, the framework aims to achieve over $1 trillion in net deficit reduction and permanently codifies more of President Donald Trump’s executive actions so future administrations cannot easily revoke them.

The roadmap was created with the help of nearly 190 RSC members spanning every House committee, and provides leadership with a “vetted, Byrd-Rule-tested menu of policies,” of which the RSC says nearly 70% has already been introduced or passed by House Republicans. In the health care space, the framework focuses on three major areas:

Reforming Insurance Premiums and Companies

• Reform the existing Affordable Care Act (ACA) enhanced Advance Premium Tax Credit (eAPTC) structure so money flows directly into the hands of patients through “Health Freedom Accounts.”

• Establish a new, parallel option for individuals to buy comprehensive health insurance coverage with lower premiums in a separate marketplace—consistent with provisions included in the New Health Options Actand MAHA Act.

• Require health insurance companies and providers to disclose cash prices for medical care and disclose out-of-network access to low-cost providers.

• Appropriate congressional funding for cost-sharing reductions (CSRs), reducing premiums by 11% for working-class Americans.
  • Score: $37 billion reduction in spending

• Codify policies included in the Lower Health Care Premiums for All Americans Act to expand Individual Coverage Health Reimbursement Agreements (ICHRAs) and offer two-year, per-employee tax credits for businesses under 50 employees and codify Association Health Plans (AHPs).

• Ensure tax parity for health sharing ministries, short-term plans, medical cost sharing and subscription-based medical care.

Addressing Rising Drug Costs

• Accelerate the development of affordable, high-quality pharmaceutical drugs by implementing provisions included in the Biosimilar Red Tape Elimination Act.
  • Score: $6 billion reduction in spending

• Codify the TrumpRx program, reducing drug prices by allowing pharmaceutical companies to bypass middlemen to provide direct discounts to patients.

• Require pharmacy benefit managers (PBMs) to pass on a portion of their rebates directly to patients.
  • Score: $18 billion reduction in spending

Eliminating Fraud, Waste and Abuse

• Eliminate Washington, D.C.’s special Federal Medical Assistance Percentage (FMAP) status.
  • Score: $9.5 billion reduction in spending

• Implement a 20% FMAP penalty for states that refuse to prohibit illegal aliens from participating in state Medicaid programs.

• Eliminate the “failed” Prevention and Public Health Fund.
  • Score: $11 billion reduction in spending

• Impose site-neutral payment requirements on hospital billing in the Medicaid program.
  • Score: $172 billion reduction in spending

• Expand language included in the OBBBA to make all non-citizen foreign nationals ineligible for Medicaid and other government benefits (i.e., SNAP, housing assistance, etc.).
  • Score: $231 billion reduction in spending

• Prohibit federal funding for illegal aliens temporarily enrolled in Medicaid prior to their formal immigration verification or enrolled via Hospital Presumptive Eligibility.
  • Score: $14.1 billion reduction in spending

• Prohibit Medicaid and ACA eAPTCs from financing gender transition procedures and elective abortions.

White House “Great Health Care Plan”

The same week, President Trump and the White House called on Congress to enact the “Great Health Care Plan,” which broadly aims to lower drug prices, lower insurance premiums, hold big insurance companies accountable and maximize price transparency. President Trump hopes to build on actions already taken in his second term to help Americans afford high-quality health care. For example, several of the proposed policies build on his previous executive orders (EOs) including “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients” and “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” The plan also builds on policies included in the OBBBA, which took significant action to reduce fraud, waste and abuse in federal health care programs. Although many of the policies have similar goals to the RSC’s proposal, the White House’s plan emphasizes certain priorities over others, with greater attention to targeting large insurance companies.

Lowering Drug Prices

• Codify the Trump administration’s Most-Favored-Nation (MFN) deals with pharmaceutical companies to ensure Americans get the same low prices for prescription drugs that people in other countries pay. Voluntary negotiated deals with the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) would be grandfathered in.

• Ensure more verified safe pharmaceutical drugs are available for over-the-counter purchase to lower health care costs and increase consumer choice.

• End kickbacks paid by PBMs to the large brokerage middlemen that deceptively raise the cost of health insurance.

Lowering Insurance Premiums

• Stop sending large insurance companies “billions in extra taxpayer-funded subsidy payments” and instead send money directly to eligible Americans to allow them to buy the health insurance of their choice.

• Fund a CSR program for health care plans—would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10%, according to the Congressional Budget Office (CBO).

Holding Large Insurance Companies Accountable

• Create a “Plain English” insurance standard by requiring health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English so consumers can make more informed decisions while purchasing insurance.

• Require health insurance companies to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites.

• Require health insurance companies to publish the percentage of insurance claims they reject and average wait times for routine care on their websites.

Maximizing Price Transparency

• Require any health care provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business and ensure insurance companies are complying with price transparency requirements.

• Require all health care providers and insurers to answer their patients up front on the prices they will be charged.
  
  

On the Horizon

Between the two proposals, Republicans seem fairly aligned on the need to address health care affordability, with several shared policy provisions. However, it appears that President Trump wants to go a step further and shift his attention toward large insurance companies, while congressional Republicans appear more focused on addressing proposals from OBBBA that were ultimately stripped out, including further changes to the Medicaid program such as reforms to FMAP and site-neutral payments.

With the midterm elections at the end of the year, Republicans only have less than a year to pass a second reconciliation bill, unless they continue to hold a trifecta. The timing to pass a second reconciliation bill is tight, and with a slim majority on the House side, Speaker Mike Johnson (R-LA) will have to ensure that his members are in lockstep.

Additionally, many Senate Republicans have not supported the RSC framework, making it more difficult to reach an agreement. As a result, the preliminary policies are likely to change, but the current proposals give valuable insights into what the Trump administration and congressional Republicans want to focus on in health care for future policymaking. A full comparison between the “Reconciliation 2.0 Framework” and “Great Health Care Plan” can be found below.

Comparison of Proposals

Proposed Policy	RSC “Reconciliation 2.0 Framework”	WH “Great Health Care Plan”
Drug Pricing
Accelerate the development of affordable, high-quality pharmaceutical drugs by implementing provisions included in the Biosimilar Red Tape Elimination Act.	X
Codify the TrumpRx program, reducing drug prices by allowing pharmaceutical companies to bypass middlemen to provide direct discounts to patients.	X	X
Require PBMs to pass on a portion of their rebates directly to patients.	X	X
Ensure more verified safe pharmaceutical drugs are available for over-the-counter purchase.		X
Insurance
Reform the existing ACA eAPTC structure so money flows directly into the hands of patients through “Health Freedom Accounts.” Send money directly to eligible Americans to allow them to buy the health insurance of their choice.	X	X
Establish a new, parallel option for individuals to buy comprehensive health insurance coverage with lower premiums in a separate marketplace.	X
Require health insurance companies and providers to disclose cash prices for medical care and disclose out-of-network access to low-cost providers. Require all health care providers and insurers to answer their patients up front on the prices they will be charged.	X	X
Create a “Plain English” insurance standard by requiring health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English so consumers can make better insurance purchasing decisions.		X
Require health insurance companies to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites.		X
Require health insurance companies to publish the percentage of insurance claims they reject and average wait times for routine care on their websites.		X
Appropriate congressional funding for CSRs.	X	X
Codify policies to expand ICHRAs and offer two-year, per-employee tax credits for businesses under 50 employees and codify AHPs.	X
Ensure tax parity for health sharing ministries, short-term plans, medical cost sharing and subscription-based medical care.	X
Fraud, Waste and Abuse
Eliminate Washington, D.C.’s special FMAP status.	X
Implement a 20% FMAP penalty for states that refuse to prohibit illegal aliens from participating in state Medicaid programs.	X
Eliminate the Prevention and Public Health Fund.	X
Impose site-neutral payment requirements on hospital billing in the Medicaid program.	X
Expand language included in the OBBBA to make all non-citizen foreign nations ineligible for Medicaid and other government benefits.	X
Prohibit federal funding for illegal aliens temporarily enrolled in Medicaid prior to their formal immigration verification or enrolled via Hospital Presumptive Eligibility.	X
Prohibit Medicaid and ACA eAPTCs from financing gender transition procedures and elective abortions.	X

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THIS DOCUMENT IS INTENDED TO PROVIDE YOU WITH GENERAL INFORMATION REGARDING GOP HEALTH CARE PRIORITIES. THE CONTENTS OF THIS DOCUMENT ARE NOT INTENDED TO PROVIDE SPECIFIC LEGAL ADVICE. IF YOU HAVE ANY QUESTIONS ABOUT THE CONTENTS OF THIS DOCUMENT OR IF YOU NEED LEGAL ADVICE AS TO AN ISSUE, PLEASE CONTACT THE ATTORNEYS LISTED OR YOUR REGULAR BROWNSTEIN HYATT FARBER SCHRECK, LLP ATTORNEY. THIS COMMUNICATION MAY BE CONSIDERED ADVERTISING IN SOME JURISDICTIONS.