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.
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.”
Thoughts from the Middle by Robert J. Fischer 