This month, many Americans with Affordable Care Act (ACA) plans opened their 2026 bills and faced unexpected costs. In response, former President Donald Trump introduced his “Great Healthcare Plan.” This plan aims to redirect government support away from subsidizing insurance and instead allocate funds directly into consumer accounts for healthcare expenses.
The details are still vague, and the shift raises concerns. Moving from a system that promotes comprehensive coverage could leave some Americans at risk. Trump has criticized the ACA subsidies put in place by the Biden administration, arguing they enrich insurance companies while leaving consumers with higher costs. While lawmakers are looking into ways to sustain these subsidies, Trump has vowed to veto any plans that don’t align with his vision.
His strategy suggests that creating Health Savings Accounts (HSAs)—which let people save money for healthcare—could replace subsidies. However, crucial questions remain unanswered, such as how much money individuals would receive, who would qualify, and whether HSAs would expand to cover care beyond current ACA limitations, including preexisting conditions.
Under current rules, HSAs have strict eligibility criteria. Only those enrolled in the lowest-tier ACA plans could benefit from government contributions, which typically come with low monthly premiums but high deductibles. Gerard Anderson, a health policy professor at Johns Hopkins University, argues that while HSAs might work for about 80% of the population, they could leave about 20% vulnerable. People who face serious health issues, like car accidents or cancer, could end up worse off.
A recent survey in Health Affairs found that 70% of health policy experts believe transferring subsidies to HSAs would make healthcare less affordable for people on the Marketplace. Only 10% thought it would improve affordability. This situation indicates broader implications for everyone, as uninsured individuals often rely on emergency care, escalating costs for those with insurance.
Data from the Government Accountability Office shows that most HSAs are held by wealthier individuals, primarily white or Asian, who are in good health. The tax advantages of HSAs mainly benefit higher-income Americans. As Nicole Rapfogel from the Center for Budget and Policy Priorities points out, many are deceived into thinking HSAs are free money, but low-interest rates and high fees often negate any benefits.
If Trump’s plan were to allow HSAs to be used for health insurance purchases, that could change things. Still, there’s a risk that people would choose cheaper, less comprehensive plans, which could lead to significant issues for everyone involved. As we consider healthcare solutions, it’s clear that careful planning and inclusivity are key to ensuring no one is left behind.
