Donald Trump’s Promises, Continued

Health services

Leave Social Security and Medicare unchanged

What has Trump done with Medicare? The Trump administration’s second-term policy focuses on deregulation and structural reforms aimed at cost reduction. The program emphasizes protecting core Medicare benefits, with a commitment to maintaining current eligibility ages and premium structures. In 2025, over 67 million people were enrolled in Medicare (including both original Medicare and Medicare Advantage plans). That number is expected to grow to 68 or 69 million over the next few years. Medicare spending reached approximately $1.1 trillion in 2024 (the most current data), accounting for about 21% of total national health expenditures and roughly 12-14% of federal spending in recent years (Kaiser Foundation).

Trump’s One Big Beautiful Bill (OBBB) lowers costs for seniors. The current law excludes anyone in the U.S. from unlawfully receiving Medicare benefits. The law states that to be eligible to enroll in Medicare as a retiree, you must be 65, have worked for at least 10 years, and be either a U.S. citizen or have been a permanent resident of the U.S. for at least five consecutive years. Trump’s OBBBeliminatedMedicare eligibility for some immigrants, including refugees, asylum seekers, and those with Temporary Protected Status. The work and age requirements are unchanged.

The fulfillment of two finalized rules that would have made it easier for very low-income Medicare enrollees to access Medicare Savings Programs (MSPs) has been delayed until October 1, 2034.

Expansion of the drug price negotiation program

In May, the Trump administration announced an expansion of the Inflation Reduction Act’s drug price negotiation program to include Medicare Part B drugs for the first time. This action added to Trump’s earlier efforts to negotiate drug prices during his first term. The Trump administration moved forward with expanding Medicare and Medicaid coverage for obesity treatments– specifically GLP-1 drugs like Wegovy, Zepbound, Ozempic, Mounjaro, and Rybelsus, when used for chronic weight management in obese patients.

The changes emerged through a series of November–December 2025 announcements, such as:

negotiated “most-favored-nation” pricing dealing with drug manufacturers (slashing costs by up to 80%)
enabling coverage under new voluntary payment models like the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) model for Part D
a similar “Weight-Loss Drug Coverage Model” for Medicare and Medicaid.

The stated objective is to initially cover around 10% of Medicare beneficiaries while also controlling federal spending. Central Management Services (CMS) has begun implementing these through the Medicare Drug Price Negotiation Program (MFP), with negotiated prices recently announced for select GLP-1 drugs.

Beyond GLP-1s, the CMS has continued the Inflation Reduction Act’s Medicare Drug Price Negotiation Program, with Maximum Fair Prices for the first ten selected Part D drugs — Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and certain insulins — with projected savings of $6 billion annually for Medicare and $1.5 billion in beneficiary out-of-pocket costs.

The Trump administration has also advanced Most-Favored-Nation pricing through voluntary models from the Center for Medicare and Medicaid Innovation (CMMI), including the GENEROUS Model and the proposed GLOBE Model. Launched in January 2026, the GENEROUS Model creates Medicaid supplemental rebates for certain Part B drugs like cancer therapies. The GLOBE Model, with a proposed launch in October 2026, will impose rebates if U.S. prices exceed those of global competitors.

These efforts coordinate with reduced prices via the TrumpRx.gov platform, launched in early 2026. The platform doesn’t sell drugs but instead connects patients to discounted most-favored-nation rates from participating manufacturers. TrumpRX is only available to those not covered by Medicare, Medicaid, or private insurance (about 8% of the nation’s population).

Medicare Premiums and Programs

In 2026, Medicare beneficiaries saw an increase in their monthly Part B premiums to $202.90 (up from $185), a higher Part D deductible of $615 (up from $590), and a rise in the Part D out-of-pocket cost cap to $2,100. Other changes include potential reductions in negotiated drug prices, stricter rules for extra benefits in Medicare Advantage plans, and the introduction of enhanced security measures.

Stricter rulesfor Medicare Advantageplans mean fewer extra benefits for Medicare beneficiaries as plans face tighter spending restrictions. Perks such as grocery cards and transportation have been cut from many Advantage programs. Free dental, vision, and gym memberships have also been curtailed.

Medicaid

Although not directly related to Medicare, it’s worth mentioning that Medicaid, the state and federal program that provides health coverage for millions of low-income Americans (about 23% of the U.S. population), was at center stage in Congress’s bid to pass Trump’s sweeping agenda.

The One Big Beautiful Bill Act (OBBB)—which Trump signed into law on July 4, 2025, includes cuts to Medicaid of almost $1 trillion over the next 10 years. As a result, the Congressional Budget Office estimates that 11.8 million Americans may lose their health insurance.

Work reporting requirements are also among the changes. These changes, which are effective January 1, 2027, require that workers document at least 80 hours per month of qualifying activities (work related or community service). Those over 65 are exempt, as are veterans with disabilities and caregivers of young and disabled dependents.

Medicare Advantage payment boost

Initially, the government payments to Medicare Advantage plans were expected to increase by an average of 5.06% for 2026. This week President Trump announced that he would not increase the government payments for Medicare Advantage plans. The Kaiser Foundation warns that this policy will likely cause providers to leave the plan. To maintain profits, insurance companies will need to cut additional benefits, and are likely to require more pre-approval of procedures.

Rural health investments

OBBB created the $50 billion Rural Health Transformation Program. CMS awarded funds in early 2026 to modernize rural health care, directly benefiting Medicare beneficiaries in designated rural areas (Kathryn Pomroy , Kiplinger). As of January 2026, states were given 52 days to pull together applications and outline how they would use the funding to improve outcomes, grow the rural health care workforce, and drive innovation.

Each state is guaranteed $100 million a year over the next five years. The rest of the money was awarded based on a series of factors — including how rural a state is, what states propose to do with the money, and whether the states adopt policies aligned with the administration’s Make America Healthy Again priorities.

There’s bipartisan excitement about rural health finally getting some attention and investment. However, Democrats and many health policy experts argue, that this temporary $50 billion infusion pales in comparison to the roughly $1 trillion in cuts to Medicaid and Obamacare, also passed by Congress last year.

Keep the Social Security retirement age unchanged

Trump has been consistent in his written platforms and in public remarks regarding this promise.

Either the government pay for, or requires insurers to pay for, in vitro fertilization treatment

Trump has billed himself as the “fertilization president.” Trump’s administration issued guidance that would allow employers to offer IVF coverage as a benefit as part of company insurance plans. The updated guidance would make opting in to fertility benefits like opting in for dental or vision benefits as part of an employer’s insurance plan. The guidance does not require employers to offer a fertility benefit. Premium costs for any fertility benefit would be dependent on a specific employer’s contributions, and which benefits the company and insurer offers.

In addition, Trump announced an agreement intended to lower the cost of a popular fertility drug. His administration reached an agreement with EMD Serono to offer its fertility drugs, including Gonal-F, as part of a “most favored nation” plan that stipulates that certain medications cannot be sold to Americans for more than the highest price overseas.

As of February 2026, Senator Tammy Duckworth claims that she has worked tirelessly to pass legislation ensuring coverage for IVF, but Republicans have blocked her efforts again. If Trump really supports expanding IVF access — which he’s shouted from the rooftops but done virtually nothing meaningful to accomplish — this should be a no-brainer. He can and should expand IVF coverage to all federal workers now.

Give a tax credit for family caregivers who take care of a parent or a loved one

On July 4, 2025, President Trump signed the Caregiver Tax Credit bill (also know as the OBBB), which provides a non-refundable tax credit that reduces your income tax. To qualify you must be an individual who provides care for a spouse, common-law partner, or a dependent person with physical or mental impairment.

Create a presidential task force to investigate the rise in chronic health problems, including autism, autoimmune disorders, and obesity

President Trump established the Make America Healthy Again (MAHA) Commission to investigate the rise in chronic health problems, including autism, autoimmune disorders, and obesity. Robert F. Kennedy Jr. chairs the commission. Kennedy’s objectives have been covered extensively by the media.

Conclusions

There has been much activity in some of these areas. President Trump is keeping his promise and has not raised the social security eligibility age. He has developed programs to tackle drug pricing and has provided a tax credit for caregivers. However, his drug pricing programs, while politically noteworthy, do not solve the problems. His promise to boost the Medicare Advantage program is now on hold. His decision to keep the program payments steady is NOT a boost. The rollout of TrumpRX makes for great press, but it is only a “drop in the bucket.”

Why Can’t Congress Find a Solution to Health Care Cost?

A Brief History

The modern U.S. healthcare system has its roots in World War II. To circumvent wartime wage controls implemented by President Franklin D. Roosevelt, employers boosted fringe benefits, notably health insurance. These benefits were later institutionalized by the Internal Revenue Service in the 1950s, when it excluded employer-sponsored health insurance from taxable income.

By 1965, significant legislative changes expanded health coverage with the establishment of Medicare and Medicaid under the Social Security Act amendment. Medicare provided healthcare to the elderly, while Medicaid expanded access to the impoverished. These programs, especially Medicare, were modeled on employer-sponsored plans which were prevalent at the time but lacked stringent cost controls. This led to a system in which healthcare providers were reimbursed based on the “usual, customary, and reasonable rate,” significantly influencing increased charges for services.

Until 1973, health care in the United States was considered a public health service provided by doctors and hospitals. Payment for such services was paid by the user or through some type of insurance plan. In 1973, President Nixon signed the Health Maintenance Organization Act (HMO) into law. The HMO model was developed in response to rising medical costs and aimed to provide a cost-effective alternative to traditional health insurance. By focusing on preventive care and establishing fixed reimbursement rates, HMOs were supposed to reduce overall health care expenditure while maintaining quality services. The Act encouraged private investment in HMOs and required employers with a certain number of employees to offer these plans alongside traditional insurance options. The definition of what an HMO is has morphed a bit over time. Today the HMO is essentially a company that blends insurance functions and health care functions. After the 1973 act, HMOs became easier to form and operate. (Daniel Polsky, health economics professor at Johns Hopkins University) Many of the early HMOs (non-profit) were bought by for-profit insurers. (Paul Starr, Pulitzer Prize author, Professor, Sociology, Princeton University)

Today, what we have is not what Nixon signed into law. The U.S. healthcare system operates through a complex hybrid model. Private insurance, primarily employer-sponsored, is the main access mode for most Americans, complemented by public programs like Medicare and Medicaid. These public programs serve critical demographic segments, with Medicare covering over 60 million elderly and Medicaid providing for over 72 million low-income individuals as of 2023.

While most Americans believe that the United States has the most advanced and best health care in the world, this is not entirely true! The facts do not support this myth. In fact, the data shows that the United States lags far behind a significant number of other nations.

The Data

A good comparative source for health care is the Office for Economic Cooperation and Development (OECD). It collects and analyzes data from each of the 100 member countries on a wide range of social, economic and health-related topics. Its data gives insight into how the health of the U.S. population compares with the health of other countries. The data compared the U.S. with other OECD member countries on three health measures: infant mortality, health spending, and life expectancy.

The results show that the United States has a higher infant mortality rate and lower life expectancy compared with most other OECD member countries. Even the top U.S. state ranked lower among member countries for the infant mortality and life expectancy measures. The United States also had the highest amount of health spending of all OECD countries.

Our Strong Points

Another good source for health statistics is the Foundation for Research on Equal Opportunity (FREOPP) Index. The Index evaluated the national healthcare systems of 32 high-income countries on four key dimensions: quality, choice, fiscal sustainability, and science and technology. Those categories were chosen to examine not only the quality of each healthcare system, but also the ability of that system to improve over time through scientific and medical advances.

The top four national healthcare systems — Switzerland, Ireland, Germany, and the Netherlands — have all achieved universal coverage in part by relying on private insurance. Those countries empower patient choice and allow private insurers to innovate without delays due to political or regulatory inaction. In addition, those systems tend to be more fiscally sustainable than the U. S. because subsidies are phased out for wealthier patients.

Ultimately, the U. S. ranked 7^th overall, a result of excellent scientific advancement (1st), good quality medical coverage (14th), and moderate choice (6^th). Such rankings allude to the nation’s relative strength in research and development along with its struggle to control rising spending on healthcare. At the same time, spending on healthcare in the United States has far outpaced other major healthcare systems without yielding better outcomes. The Index makes clear that pure scientific advancement is not enough to create a strong healthcare system; it is necessary to control rising costs and ensure that high-quality healthcare is accessible to every American

Congress and Fiscal Sustainability

The United States is positioned last (32nd) in Fiscal Sustainability, primarily due to its exceptionally high government health spending, which is the highest globally. Per capita spending reached $13,500 for this year’s Index, of which nearly $7,500 is public spending. For comparison, Switzerland, with the second-highest health spending, recorded a per capita expenditure of $9,200 but only $1,999 in public spending. The fiscal outlook for the United States is likely to worsen as healthcare inflation continues to escalate the costs associated with subsidies for Medicare, Medicaid, the employer tax exclusion, and the insurance exchanges under the Affordable Care Act.

Switzerland achieves universal coverage through a tightly regulated private insurance market, ensuring that everyone has access to essential care. By contrast, the U.S. relies on a fragmented mix of private and public systems, resulting in higher costs, uneven access, and significant administrative complexity.

Perhaps the biggest obstacle to an affordable universal health care policy is the insurance lobby (HMOs) The insurance lobby wields substantial influence over US health policy through massive financial investments, strategic lobbying, and close relationships with lawmakers. This influence shapes legislation, regulatory priorities, and public program funding—often prioritizing industry interests over consumer outcomes. The scale of spending and the number of lobbyists involved underscore the lobby’s power, while public opinion reflects widespread concern about its impact.

What role does the insurance lobby play in the failure of meaningful reform? America’s Health Insurance Plans (AHIP), the industry’s main trade group, spent over $4.2 million on lobbying in just three months (July–September), marking its highest level on record for that period. This level of spending isn’t an outlier; it reflects a long-term strategy of saturating Congress with data, arguments, and pressure.

The industry is currently fighting hard to preserve enhanced Affordable Care Act subsidies, which are set to expire unless Congress acts. These subsidies directly affect millions of Americans and billions in insurer revenue. Insurers have made this extension a top legislative priority, coordinating with hospitals and other health‑sector players through coalitions like Keep Americans Covered.

Lobbyists emphasize that in today’s Washington, direct engagement (“the inside game”) is more likely to produce favorable outcomes. This means constant meetings, briefings, and relationship‑building with lawmakers and staff. The industry’s approach is sophisticated: they combine economic arguments, constituent‑impact data, and political pressure to shape legislative outcomes.

Bottom Line

The health insurance lobby wields significant, sustained influence over Congress. Their power comes from: enormous lobbying budgets, deep relationships with lawmakers, coalitions that amplify their message, and the economic stakes tied to federal health policy

They don’t win every fight, but they remain one of the most formidable players in federal policymaking. Other major lobbies which influence health policy include pharma, hospitals, and the health technology industry.