There’s a reason the saying goes, “If it sounds too good to be true, it probably is.” That’s exactly how President Donald Trump’s newest healthcare pitch lands: send money “directly to the people so that they can purchase their own, much better healthcare.”
What Republicans are floating may look simple on the surface, but it’s a raw deal for working families and a great deal for the wealthy. Instead of continuing Affordable Care Act (ACA) subsidies that lower monthly premiums, this proposal could steer millions into high-cost plans that force you to pay thousands out of pocket before insurance helps at all. Premiums could rise, the ACA marketplaces could destabilize, and coverage for millions could become less affordable and less reliable. That’s not reform — that’s risk.
Let’s start with the basics. People already receive help paying for health insurance. Right now, that help works like a discount applied upfront. The government provides a subsidy tied to ACA plans, which reduces your premium before you buy. The result is straightforward: you shop for a plan, see the real price you’ll pay each month, and choose what fits your health needs and your budget. You don’t have to guess, and you don’t have to front thousands of dollars just to access care.
The Republican alternative flips that structure. Instead of supporting premiums directly, they want to deposit money into health savings accounts (HSAs). That might sound empowering, but HSAs only work with high-deductible health plans — policies that don’t pay for most care until you hit a large deductible. In 2025, the average deductible for a family in these plans was close to $7,000.
Sure, these plans often come with lower monthly premiums, so they can look attractive on paper. But the catch is brutal: you won’t know what care will really cost you when you need it. A doctor visit, tests, prescriptions — all of that comes out of your pocket until you reach that deductible.
Yes, an HSA can help cover some of those costs. But what happens when that account runs dry and you still haven’t reached the deductible? People delay care, skip appointments, or end up choosing between seeing a doctor and paying for groceries. That’s not budgeting — it’s triage.
And the pressure doesn’t stop there. Families who can’t pay upfront often go into debt. Medical debt is already crushing millions of households; this plan would pour gasoline on that fire. Even worse, you’d still be paying a monthly premium for coverage you can’t realistically afford to use.
Then comes the part that makes this proposal especially lopsided: it rewards the rich more than everyone else. HSA contributions are tax-free. That means higher-income households get a larger financial payoff. A married couple earning $800,000 saves about 37 cents on every dollar they put into an HSA, while a couple earning $30,000 saves only about 12 cents. The wealthier you are, the bigger the benefit — and the wider the gap grows.
The ACA isn’t perfect, and nobody should pretend it is. But replacing upfront premium help with a system that pushes families into high deductibles, higher uncertainty, and greater debt is not an upgrade. If the goal is to lower costs and improve access, this plan moves in the opposite direction.
