President Donald Trump delivered a record-breaking State of the Union address on Tuesday night, clocking in at 108 minutes, but touched on healthcare issues for only five of them.
Healthcare has been a major political issue in recent months, with conflict between lawmakers over the ACA tax credits and a range of other issues, but Trump did not choose to focus extensively on health.
While the marathon speech touched heavily on immigration, tariffs, and inflation, Trump still utilized the platform to launch a sharp attack on the Affordable Care Act (ACA) and promote his “Great Healthcare Plan.”
Trump mocked the ACA as the “Unaffordable Care Act,” claiming the government has provided “hundreds and hundreds of billions of dollars a year” to insurance companies while their stock prices soared.
He proposed a shift under his Great Healthcare Plan, unveiled in January 2026, to “stop all payments to big insurance companies” and instead provide that money directly to individuals to purchase their own care.
Policy experts noted that the plan appears to draw from Senate proposals by Republicans Rick Scott and Bill Cassidy. These proposals involve channeling federal funds into accounts similar to Health Savings Accounts (HSAs), paired with high-deductible coverage.
However, critics were quick to challenge Trump. Michael Baker, director of healthcare policy at the American Action Forum, stated that redirecting dollars “only changes who pays and doesn’t address the cost of care itself.” Wendell Primus of the Brookings Schaeffer Initiative added that giving money directly to consumers “invites fraud” and noted that the ACA has reached “all-time lows” in uninsurance rates.
Trump also touted his “Most Favored Nation” drug pricing agreements, claiming Americans would now pay the “lowest price anywhere in the world.” He highlighted TrumpRx.gov, a new website aggregating direct-to-consumer deals negotiated with pharmaceutical companies.
To highlight this initiative, Trump introduced Catherine Rayner, claiming she saved $3,500 on in vitro fertilization (IVF) drugs through the site. However, analysis of the website shows it currently lists only 43 drugs, a small fraction of the market. Furthermore, the listed discounts for the specific fertility drugs mentioned by Trump total $1,658.46, significantly less than the $3,500 savings he cited.
The president pivoted to social issues by highlighting the story of Sage Blair, a guest in the gallery whose school reportedly sought to “socially transition” her without her parents’ consent. Trump called for an immediate national ban on states transferring children to a “new gender” without parental consent.
But anti-abortion campaigners will have been disappointed that the president did not touch upon that controversial subject at all.
Despite the president’s optimistic tone, some observers viewed the healthcare portions of the speech as a “political two-step.” Tom Miller of the right-leaning American Enterprise Institute argued that the stance was more of a “political deflection” than a concrete alternative to restoring recently expired ACA tax subsidies.
Other critics countered Trump’s claim that “no other president” had tried to lower drug prices, pointing to the Inflation Reduction Act under the Biden administration, which saved $6.3 billion through Medicare drug price negotiations.