The current administration’s health care agenda centers on lowering prescription drug costs, expanding insurance coverage through the Affordable Care Act marketplace, and protecting patients from unexpected medical bills. Rather than a single sweeping plan, it’s a collection of policies enacted through legislation (primarily the Inflation Reduction Act of 2022), executive orders, and regulatory changes. Here’s what each piece actually does for you.
Lower Prescription Drug Costs for Medicare
For the first time, Medicare can now directly negotiate prices with drug manufacturers. The first round of negotiations covered ten of the most commonly used and expensive drugs: Eliquis and Xarelto (blood thinners), Jardiance and Farxiga (diabetes and heart failure), Januvia (diabetes), Entresto (heart failure), Enbrel (autoimmune conditions), Imbruvica (blood cancer), Stelara (autoimmune conditions), and NovoLog/Fiasp (insulin). The negotiated prices take effect January 1, 2026, with additional drugs expected to be added in future years.
Alongside negotiation, a hard cap on out-of-pocket drug spending kicks in for Medicare Part D enrollees in 2025. No one on Medicare will pay more than $2,000 per year for their covered prescriptions, adjusted for inflation after that. Before this change, people with cancer, autoimmune diseases, or other conditions requiring expensive medications could face bills of $10,000 or more annually. The cap also eliminates the old “donut hole” problem where coverage would temporarily shrink after hitting a spending threshold.
The $35 Insulin Cap
If you’re on Medicare, your cost for a one-month supply of any covered insulin product is capped at $35, with no deductible. This applies to insulin covered under both Part B (for use with insulin pumps classified as durable medical equipment) and Part D (injectable insulin, inhaled insulin, and insulin used with patch pumps or disposable-cartridge pumps). Part D plans also cover related supplies like syringes, needles, gauze, and alcohol swabs. For the roughly 3.3 million Medicare enrollees who use insulin, this replaced what had been unpredictable and sometimes steep monthly costs.
ACA Marketplace Subsidies
Enhanced subsidies that make Affordable Care Act marketplace plans cheaper have been a cornerstone of the administration’s coverage strategy. These boosted premium tax credits, originally passed during the pandemic and extended through the Inflation Reduction Act, reduce monthly premiums significantly for low- and middle-income enrollees. Record enrollment numbers on the ACA marketplace followed.
These enhanced credits are set to expire on December 31, 2025. If Congress does not extend them, the average enrollee who receives a subsidy faces a roughly doubling of their premium payments for the same plan. Older adults would be hit especially hard, since ACA plans are allowed to charge them more based on age. Whether these credits survive will likely be one of the biggest health care fights in the near term.
Protection From Surprise Medical Bills
The No Surprises Act, which took effect in January 2022, prevents you from receiving a massive bill when you unknowingly receive care from an out-of-network provider. This most commonly happened in emergencies (you can’t choose which hospital the ambulance takes you to) or when an out-of-network specialist, like an anesthesiologist, treated you at an in-network hospital.
The impact has been significant. Insurance industry estimates suggest the law has prevented more than one million surprise bills per month since implementation. Compared to 2019, out-of-network bills for emergency services dropped 24 percent by 2022, and the average out-of-pocket payment on those bills fell 54 percent. For non-emergency services at in-network facilities (the anesthesiologist scenario), out-of-network bills declined 17 percent and out-of-pocket costs dropped 32 percent.
Mental Health Parity Rules
In September 2024, federal agencies finalized new rules to close loopholes in mental health coverage. The core principle: your insurance plan cannot make it harder to access mental health or substance use treatment than it is to access care for a physical condition. In practice, insurers had been skirting this through indirect restrictions, like requiring prior authorization for therapy visits but not for comparable medical appointments, or maintaining thinner networks of mental health providers.
The updated rules require insurers to collect data on whether their policies create measurable differences in access to mental health care versus physical health care, and to take action if they do. Plans are also now explicitly banned from using criteria that are specifically designed to limit mental health and substance use benefits. This covers network composition (how many therapists and psychiatrists are in-network), reimbursement rates for out-of-network providers, and the types of medical management techniques applied to claims.
Reproductive Health Protections
Following the Supreme Court’s reversal of Roe v. Wade, the administration issued executive orders directing federal agencies to protect access to contraception, emergency contraception, and emergency medical care for pregnancy-related complications. Specific actions include reinforcing that hospitals receiving Medicare funding must provide stabilizing care under federal emergency medicine law, regardless of state abortion restrictions. This applies to patients experiencing miscarriages, ectopic pregnancies, and other emergency conditions during pregnancy. Additional directives focused on expanding awareness of contraceptive services and know-your-rights information for patients and providers.
What Didn’t Happen: The Public Option
During the 2020 campaign, a government-run “public option” insurance plan was a signature proposal. The idea was to create a federal plan that would compete with private insurers on the ACA marketplace, theoretically driving down prices. It never materialized. The phrase essentially disappeared from the administration’s public remarks after December 2020, blocked largely by opposition from hospitals concerned about lower reimbursement rates and the political math of passing it through Congress. The policy was never formally abandoned, but it was never seriously pursued either.
Telehealth and Primary Care
The pandemic-era expansion of telehealth access became a lasting policy priority. Medicare coverage of telehealth visits, which previously required patients to travel to specific approved sites, was broadened to allow care from home. The administration has also pushed value-based payment models that reward primary care practices for keeping patients healthy rather than billing for each individual service. These changes are less visible to most people than drug pricing or insurance subsidies, but they shape how care is delivered, particularly in rural areas where provider shortages make in-person visits difficult.