President Trump is blaming health insurers for rising health care costs, adopting a populist approach as he seeks to counter attacks by Democrats that the GOP has done too little to keep health care affordable.
Democrats are pushing Congress to quickly hold a vote on extending the Affordable Care Act (ACA) enhanced premium tax credits scheduled to expire at the end of this year. Trump is reportedly preparing a proposal that would extend the subsidies for two years, along with a series of reforms favored by Republicans, but delayed an announcement facing GOP pushback.
Whether or not a deal gets done, Democrats have used the shutdown to put Republicans on defense over health care, and Trump and his allies are looking to reframe the conversation by making insurers enemy No. 1.
“I’m sure the White House realizes that, you know, having premiums increase on voters ahead, especially heading into an election year where affordability is a big conversation, is not ideal politically,” one GOP campaign strategist told The Hill. “They may come to some kind of deal, but that will kind of maybe help alleviate the attention that’s being directed at insurance companies right now. But healthcare is still going to be a big issue.”
Trump said last week he would only support a plan involving “sending the money directly back to the people,” aiming to circumvent insurance companies.
“The only healthcare I will support or approve is sending the money directly back to the people, with nothing going to the big, fat, rich insurance companies, who have made $trillions, and ripped off America long enough,” Trump wrote on Truth Social.
This messaging aligns with voters’ perceptions of high health care costs. In polling released last month, 63 percent of voters said insurance companies were the most responsible for medical debt. Seventy-six percent of voters said they wanted the country to switch to a different health insurance system in which they can be unemployed or self-employed and still remain insured.
As the GOP strategist noted, Democrats have long held an advantage over Republicans when it comes to health care.
“One thing about President Trump is he’s one of the best politicians in recent memory who is able to seize on an issue that has historically been a strength for the opposing party and make it his own. And so, I think it’s smart for him to focus on it.”
According to Robert Cahaly, chief pollster and senior strategist for the right-leaning polling firm the Trafalgar Group, the success of Trump’s messaging will depend on rallying Republicans around an alternative to the unpopular status quo.
“If they can have something to present, even if it’s just in a rough form, and the perception is the Democrats are killing it and they’re in favor of Obamacare because the Democrats are beholden to the insurance companies and not to the people, then the Democrats lose the compassion game,” said Cahaly.
“We think the idea is going to be popular because there is this thought that the insurance companies have been the ones who’ve gotten rich on Obamacare,” Cahaly added. “And it is bipartisan, and we have one of the only nonpartisan things that Obamacare people agree with.”
Polling has found that most people are in favor of extending the enhanced ACA premium tax credits. In a KFF Health Tracking Poll released this month, 74 percent said they were in favor of Congress extending the credits rather than letting them expire. Cahaly argued this sentiment can be addressed with the right messaging.
“Extending ACA tax credits is not popular nationwide if you ask the question properly and you say, these are tax credits that started under Covid and continue to be paid even in a post-Covid economy,” said Cahaly. “When you explain these are Covid-era tax credits that are continuing, no it is not popular.”
When reached for comment by The Hill, the health insurance trade group AHIP pointed out that health plans are the only part of the health care system in which profits and administrative costs are capped by federal law. AHIP further noted that health plans’ profit margins fell to 0.8 percent last year, according to the National Association of Insurance Commissioners.
By comparison, profit margins in the pharmaceutical industry have consistently remained in double digits range. The Campaign for Sustainable Rx Pricing found that between 2017 and 2023, the pharmaceutical industry’s average annual net income margin was roughly 23 percent.
“Premiums reflect the underlying cost of care,” AHIP spokesperson Chris Bond said in a statement. “And if you look at the breakdown of where Americans’ premium dollars go, upwards of 24 cents of each dollar goes toward prescription drugs, over 40 cents on the dollar goes toward hospital costs. And those costs, both from drug makers and hospitals, continue to rise, and that’s what’s represented in premiums.”
Chanse Jones, spokesperson for the pharmaceutical trade group PhRMA, responded that its members were actively seeking ways to cut costs while investing in the development of new drugs.
“Biopharmaceutical companies are stepping up with major commitments — including hundreds of billions in new U.S. manufacturing and R&D investments — to help make medicines more affordable and accessible,” he said in a statement. “We’ll continue working with the administration and others across the health care system to advance solutions that put patients first.”
Many of these investments have included commitments to build manufacturing facilities on U.S. soil, a key part of Trump’s Most Favored Nation drug price policy. Joe Antos, senior fellow emeritus at the American Enterprise Institute, said he believes Trump’s policies indicate he is “fundamentally not interested” in health care policy.
“He thinks of himself as a deal maker,” said Antos. “He’s a very transactional person. I don’t think he’s particularly driven by, you know, somebody else’s theories about where costs come from. He wants to make deals.”
And while some pharmaceutical giants have been willing to play ball, health insurers have been unable to find their way into Trump’s good graces.
Antos said identifying who is to blame for the high cost of health care ultimately means little to voters without substantial change to bring prices down.
“The fact is that what the average patient wants to know is what’s it going to cost me, meaning what’s going to come directly out of my pocket,” he told The Hill.
“The target for the average person is not what the insurer paid. The target is what I’m going to get paid, going to get charged, after all is said and done.”