President Donald Trump’s February 24, State of the Union address devoted a brief portion of the speech to health care policy, highlighting some of his priorities. The President focused primarily on three themes: expanding price transparency, reducing prescription drug prices and addressing Medicaid fraud. These policy issues were framed within a broader narrative about lowering health care costs for American families. On February 23rd, the Congressional Budget Office (CBO) released updated spending projections showing that federal health programs will cost over $26 trillion through 2036, making health care the largest category of federal spending. Medicare spending is projected to nearly double over the next decade (from $1,180 billion in 2025 to $2,421 billion in 2036), constituting 4.2% of the nation’s Gross Domestic Product (GDP) by 2036.  

In discussing health care costs, President Trump stated, “I’m also confronting the crushing cost of health care,” while criticizing the Affordable Care Act (ACA) and broader structural problems in the health care system. These comments come at a time when health care affordability remains a major concern for consumers surveys conducted early this year indicate that a large portion of Americans report being worried about their ability to afford health care costs, including insurance premiums, deductibles, and out-of-pocket expenses. 

Recent changes in the insurance market have contributed to that concern. Enhanced Affordable Care Act premium subsidies that were expanded during the COVID-19 pandemic expired at the end of 2025. Analyses suggest enrollees are experiencing sharp increases in their monthly premiums following the expiration of those subsidies – with premiums rising by 21.7% and deductibles for the less costly plans ranging from $5,000 to $7,500. Affordability discussions in 2026 will continue to occur against a backdrop of these policy-driven and market-driven cost pressures. 

Price transparency continues to be a top priority for President Trump in his efforts to lower costs. His administration plans to increase price transparency, with the President stating, “I want to stop all payments to big insurance companies and instead give that money directly to the people, so they can buy their own health care, which will be better health care at a much lower cost. In addition, my plan requires maximum price transparency.” 

The federal hospital price transparency rule has continued to be refined by CMS through rulemaking and enforcement actions, including higher penalties and updated reporting requirements intended to improve compliance and usability of pricing data. Despite these efforts, the requirements haven’t moved the needle much. While transparency may help reveal variation in pricing across providers and markets, the health care costs most impactful to consumers, such as insurance premiums and deductibles, are influenced by broader factors including underlying medical spending, pharmaceutical costs, and insurance market dynamics. The machine-readable files required are also not accessible to consumers due to how significantly large they are. Analysts note that price transparency data is often used more actively by competing providers, insurers, and market analysts than by individual patients, and in certain cases public disclosure of negotiated rates may contribute to upward price convergence as competitors benchmark their prices against higher-priced peers. 

In addition to transparency, the president devoted part of his speech to prescription drug pricing. President Trump argued that Americans have historically paid significantly higher prices for prescription medications than patients in other developed countries and asserted that new policies would change that dynamic. He stated that Americans who once paid the highest drug prices would now pay “the lowest price anywhere in the world,” referencing the Administration’s “most-favored-nation” approach that seeks to align U.S. drug prices more closely with those paid internationally. He also urged Congress to codify this “Most-Favored-Nation” framework in federal law, creating a more permanent legislative foundation for drug pricing reforms. 

The President also highlighted initiatives intended to allow consumers to purchase certain medications at discounted prices through the new direct purchasing platform, TrumpRX. These efforts are designed to bypass some traditional distribution channels and potentially reduce costs for patients paying out of pocket. At the same time, questions remain about how broadly such programs may apply across different medications and patient populations, as well as how they would interact with existing insurance coverage structures. For more information on this program, click here. 

President Trump also declared a national “war on Medicaid fraud,” singling out states like Minnesota, Maine, California, and Massachusetts. Vice President JD Vance was appointed to lead this initiative, which includes a nationwide moratorium on Medicare enrollment for certain durable medical equipment and a Request for Information on preventing fraud (see the next article for more information).    

Taken together, the health care remarks in the 2026 State of the Union reinforce several themes that have characterized federal health policy debates in recent years: lowering prescription drug prices, increasing transparency in health care markets, and emphasizing competition as a mechanism for controlling costs.