Yesterday aboard Air Force One, President Trump was asked by a reporter if he supported Senators Bill Cassidy (R-LA) and Mike Crapo’s (R-IN) new health care proposal, which would authorize $1,500 deposits in Health Saving Accounts (HSAs) for lower-income individuals to replace the expiring Affordable Care Act (ACA) subsidies. The president’s response to the question was telling. And it shows just how much Big Insurance has fallen from grace in recent months.

For decades, merely expressing disenchantment with private health insurers could get you labeled as a socialist. Now we are seeing daily criticism of health insurance companies from people across the political spectrum, leading one to not know if a quote like “Americans are getting crushed by health insurance with monthly payments” is coming from a progressive, like AOC, or a conservative like MTG. (Hint: that quote was from MTG). Trump’s response was in the same vein and could lead one to believe there is a chance of the left and right finding common ground in holding insurance companies accountable for their greed.

Where Trump is right. Where Trump is wrong.

Below we will dissect the president’s response and explain where he’s right and wrong.

“I like the concept [of the Cassidy-Crapo legislation]. I don’t want to give the insurance companies any money. They’ve been ripping off the public for years.“

This is true. Big Insurance has been ripping us off for years. And almost all of insurers’ growth in recent years has come from us as taxpayers. Most big insurers now make far more money on the lucrative Medicare Advantage business and managing state Medicaid programs than from their commercial health insurance plans. And they’ve even figured out how to bilk the VA. UnitedHealthcare, the biggest insurer, now gets more than 75% of its revenues from taxpayer-funded programs. And yes, insurers are getting hundreds of billions of dollars every year from the ACA subsidies that are at the center of debate in Washington.

Here are a couple of examples. Private health insurers took in over $500 billion in tax dollars to administer Medicaid in 2023. And this year alone, they will be overpaid – yes overpaid – $85 billion as a consequence of how they’ve rigged the Medicare Advantage program.

Insurers also take in massive amounts of money in the form of premiums that people pay thinking that money goes to care. Much of that money ends up going toward things (and people) that do nothing to get us well or keep us well. Since 2014, the seven largest insurers have made over $500 billion in profits, and they used $146 billion to buy back their own stock. So yes, Trump is correct, health insurance companies have been ripping people off for years.

“Obamacare is a scam to make the insurance companies rich.”

No, Mr. President, the ACA is not a scam and most Americans now know that it has done a lot of good for a lot of people. Among other things, it made it possible for millions of people who previously had been blackballed by insurers because of a preexisting condition to finally get coverage. It brought us many long-overdue consumer protections, outlawed junk insurance, enabled young people to stay on their parents policies until they turned 26, alleviated job-lock through the creation of the ACA (Obamacare) marketplaces, and it made millions more low-income families eligible for Medicaid.

But, the president is right to say that Big Insurance has gotten rich since the passage of the ACA. Between 2014 (the year the entirety of the ACA was implemented) and 2024, just seven for-profit health insurers amassed $543.4 billion in profits and took in a staggering $10.192 trillion in revenues.

“And they have made, I mean, you look, $1,400 to $1,700 increase, 100 percent increase over the last number of years. There’s really few things that have gone up like insurance companies.”

The president is kind of right. As KFF reports, the cost of a family policy has increased 60% since 2014 – a rate of increase much higher than general inflation and also higher than medical inflation. And as we’ve published previously, not only has the total cost of an employer-sponsored plan skyrocketed, so has the share of premiums workers must pay. This year, employers deducted an average of $6,850 from their workers’ paychecks for family coverage, up from $4,823 in 2014. And keep in mind, all that money our employers are having to send to insurance companies is not money that’s available to give raises to workers or hire more people.

“They’re getting numbers and money like nobody’s ever seen before. Billions and billions of dollars is paid directly to insurance companies. We’re not going to do that anymore.”

The president is right. Several Big Insurance companies have ballooned in size over the past decade to become some of the world’s biggest corporate conglomerates. UnitedHealth Group, CVS/Aetna and Cigna are now numbers 3, 5 and 13 on the Fortune 500 list. The only American companies that take in more revenue than UnitedHealth are Walmart and Amazon.

“I believe Obamacare was set up to take care of insurance companies, not to take care of the American public.”

The president has his history wrong here. While there are plenty of Monday-morning-quarterbacking you can do for the ACA – the law was not passed to “take care of insurance companies.” While the ACA didn’t fix everything – not by a long shot – it did stop some of the insurance industry’s worst abuses, like refusing to sell policies to people with preexisting conditions – even acne – and “rescinding” policies to avoid paying for life-saving care. Some insurers were found to be paying employees bonuses to find policies to rescind, including the policies of women almost immediately after being diagnosed with breast cancer.

It prohibited health insurers from charging people more because of a preexisting condition and from dumping the sick so they could reward their shareholders more generously. Keep in mind that insurers consider every claim they pay as a loss, hence the term “medical loss ratio” (MLR), which the ACA addressed by requiring insurers to spend at least 80%-85% of our premiums on our health care.

And it’s not like Big Insurance wanted the ACA to pass. Back in 2010, America’s Health Insurance Plans (AHIP), the PR and lobbying group for health insurers, quietly funneled $100 million to the U.S. Chamber of Commerce to orchestrate a PR, advertising and lobbying blitz to keep the ACA from being passed.

While big health insurance companies have only grown since the passage of the ACA, it has been Big Insurance’s corporate maneuvers and work on Capitol Hill (not the law itself) that has allowed these companies to flout some of the ACA’s regulations and bend the law to do their will.

“I love the idea of money going directly to the people, not to the insurance companies. Going directly to the people. It could be in the health savings account. It could be a number of different ways.”

While that is a compelling sound bite, it’s disingenuous. The money proposed by Cassidy and Crapo to go to HSAs would then be used by enrollees to buy insurance, thus still giving money to the insurance companies. Even worse, the proposed amount of money to go to people’s HSAs to help them pay for health insurance and care is $1,000-$1,500. This is money that would be used to purchase a bronze or copper plan with a high deductible (with many of those plans having deductibles north of $5,000). That means under this plan people would still need to come up with thousands to meet their deductible on top of paying their premiums every month. $1,000 wouldn’t come close to even covering the premiums for a decent policy, much less the out-of-pocket costs.

Replacing ACA subsidies with HSAs would still keep Americans tied to the same private health insurers that Trump calls “big, bad” and “money-sucking.” Most families would still be exposed to crippling medical bills, and even more tax dollars would flow to insurance conglomerates that own HSA custodian businesses (like UnitedHealth’s Optum Bank).

“And the people go out and buy their own insurance, which can be really much better health insurance, health care.”

That’s wishful thinking far removed from reality. The health insurance plans available to people who get money for their HSAs under the Cassidy-Crapo proposal – rather than getting subsidies – are the same as those currently available. Worse, without the subsidies, people will not be able to afford the gold or silver plans that have lower out-of-pocket costs. In reality the plans that people buy under the proposed Cassidy-Crapo plan would have less value than the plans they previously bought with subsidies.

Trump’s comments are coming ahead of tomorrow’s scheduled vote in the Senate on dueling Democratic and Republican proposals to deal with the enhanced subsidies for ACA plans that will expire in three weeks. Without those subsidies, premiums will spike for many of the 24 million American enrolled in “Obamacare” plans. Democrats want to extend the subsidies for three years. Republicans, led by Senate Majority Leader John Thune, will push a plan replacing those subsidies with direct payments into individuals’ Health Savings Accounts (HSAs), as the president is suggesting. Neither plan is expected to get the 60 votes required for passage. What happens next is anybody’s guess.

Over 17 million nonelderly Californians (55%) received health benefits through an employer in 2023. The California Health Benefits Survey (CHBS) tracks trends in these workers’ coverage, including premiums, employee premium contributions, cost sharing, offer rates, and employer benefit strategies. In 2025, the survey also included questions about provider networks, coverage for GLP-1 agonists, premium cost drivers, and employee concerns about utilization management. The CHBS is jointly sponsored by the California Health Care Foundation and KFF.

KEY FINDINGS INCLUDE:

• Premiums for covered workers in California are higher than premiums nationally. The average annual single coverage premium in California is $10,033, higher than the national average of $9,325. The average annual family premium in California is $28,397, higher than the national average of $26,993.
• Overall, the average family premium has increased annually by 7% in California and 6% nationally. The average single premium has increased 8% annually in California and 6% nationally. Since 2022, the average premium for family coverage has risen 24% in California, higher than national measures of inflation (12.2%) and wage growth (14.4%).
• Workers are typically required to contribute directly to the cost of coverage, usually through a payroll deduction. On average, covered workers in California directly contribute 14% of the premium for single coverage and 27% for family coverage in 2025. These shares vary considerably, and some workers face much higher premium contributions, especially for family coverage.
• A lower share of covered workers in California face a general annual deductible for single coverage than covered workers nationally (75% vs. 88%), and the average deductible is lower ($1,620 vs. $1,886). The share of California covered workers with a deductible has increased since 2022 (68% to 75%).
• Employers in California are significantly less likely than employers across the nation to say there were sufficient mental health providers in their plans’ networks to provide timely access to services.
• Many employers report concerns about out-of-pocket costs: 47% of firms offering health benefits indicate that their employees have a “high” or “moderate” level of concern about the affordability of cost sharing in their plans. About one in 10 covered workers in California faces a general annual deductible of $3,000 or more for single coverage.
• Large California employers view drug prices as a major driver of rising premiums. Thirty-six percent of large firms report that prescription drug prices contributed “a great deal” to premium increases.
• Over one-quarter of large firms (28%) offering health benefits in California say they cover GLP-1 agonists when prescribed primarily for weight loss. Nearly one-third of these firms report higher-than-expected utilization of this benefit.

Read the full report on the KFF website or download it below.

Key Takeaways:

• 2026 is a pivotal year for U.S. healthcare.
• Structural, regulatory and competitive changes will alter the landscape.
• 10 areas will likely be the foci.

Last week…

• the stock market took a dive largely due to tech company volatility resurrecting fears of an A.I. bubble.
• reports from the Departments of Labor and Commerce confirmed mixed signals about the economy: job growth was relatively strong but inflation (3%) remained stubbornly above its 2% target and consumer confidence slid.
• Target warned Black Friday sales later this week will likely signal softness in consumer spending, and
• Congress returned to DC after its 43-day shutdown that ended with no agreement on extension of insurance tax credits that expire at year end.

This week, Thanksgiving will likely slow down things on the U.S. domestic front but not for healthcare. Unlike just about every other industry in the economy, we operate 24/7/365. And like some industries, demand for our services is hard to predict– acts of God, accidents, court decisions, regulatory policy changes, social media “experts” et al. make predictions educated guesses at best. New technologies, clinical innovations, A.I. and private capital keep planners off-balance. Short-terms plans are more defensible; longer-term plans more challenging.

Thus, the industry is understandably focused on 2026.  Here are assumptions:

• Affordability for groceries, transportation, housing and healthcare (premiums and out-of-pocket) will drive media attention, public opinion and voting November 3, 2026.
• Congress will not extend tax credits that expire at year-end prompting a spike in the uninsured and under-insured populations. In tandem, large private insurers will raise premiums and increase leverage with providers to reduce competitive threats.
• Media coverage of healthcare will feature sensationalism, soundbites and hyper-simplification: costs (affordability), prices, disparities, executive compensation, outcomes, community benefits, workforce dissatisfaction, profitability and business practices will be foci.
• Warfare between hospitals, insurers, and drug manufacturers will intensify. Each will assert their systemic reform proposals serve the greater good best by protecting themselves against unwelcome threats.
• States will be the epicenters of health system transformation. Federal changes will be paralyzed by partisan-brinksmanship and posturing for 2026 and 2028 elections.
• Trust and confidence in the health system will decrease (further) to record levels of discontent.

And, reflecting on the current state of affairs in U.S. healthcare, here are 10 healthcare headlines you MIGHT see next year:

• Employed physicians win class action challenge to hospital employment agreements citing clinical independence, excessive administrative costs concerns
• IRS cuts not for profit health systems tax exemptions. Private investments, community benefits, executive compensation cited
• UnitedHealth Group completes acquisition of HCA: sets stage for new era of competition in U.S. healthcare
• EPIC completes interoperability agreement with CMS: public-private oversight board named
• Congress passes most favored nation pricing for biologics, specialty drugs as states enact price controls
• Large employers drop employee coverage due to costs, systemic flaws in system
• Health and wellbeing services consolidated under HHS to integrate social services and health
• Primary care physicians, nurse practitioners, community pharmacists launch national society to advance primary and preventive health services
• CMS capitates, expands primary care services in restructured MSSP program
• National coalition launched to design transformed system of health that’s accessible, affordable, comprehensive, efficient and effective

And, I’m confident, many others.

2026 is a mid-term election year. In 2016 (Trump 45 Year One), Republicans controlled 31 governorships and 68 legislative chambers. This January, the GOP will control 26 governorships and 57 legislative chambers– a 15% reduction on both. Politics is divided, affordability matters most to voters and healthcare is a high-profile target for campaigns so humility, thoughtful messaging backed by demonstrable actions will be an imperative for every healthcare organization.

2026 is a HUGE year for U.S. healthcare. The outcome is unknown.