For those paying attention to healthcare and interested in what the government can do to help in the never-ending battle to keep costs in line, I’d like to share my perspective on The Great Healthcare Plan. fact sheet released on January 15, 2026.
I appreciate the simplicity of the document compared to typical government publications, and it does address the right issues. However, as the saying goes, “the devil is in the details,” and there are not many details available yet.
February 5th, 2026
AUTHOR(S)
Robert DeNinno, Jr.
Principal, Precision Benefits Group
Lower Drug Prices: Tackling the Biggest Cost Driver
Anyone who has spent as much time as I have trying to contain medical spend knows that drug costs are arguably the largest contributor to overall healthcare costs. The idea of lowering these costs is a noble one. However, nearly every administration has attempted to tackle this issue, and over the last several decades, Big Pharma has consistently prevailed.
In an era of partisanship, this is truly a bipartisan problem. The fact that different countries pay vastly different prices for the same drugs is a major issue—especially for the U.S., where costs are typically the highest. Addressing this, along with the proposal to make more drugs available over the counter, would clearly have an adverse effect on pharmaceutical company profits. I remain optimistic, but I will need to see real action before I’m convinced.
Lower Insurance Premiums and ACA Cost-Sharing Reform
This section targets the Affordable Care Act (ACA), which was implemented during the Obama administration on March 23, 2010. While the ACA paved the way for over 35 million Americans to gain access to healthcare coverage, it did so by providing government funds to help individuals purchase insurance through health insurance exchanges.
The argument is that this approach effectively enriched insurance companies by delivering more than 35 million new policyholders paying premiums. The Great Healthcare Plan proposes creating a cost-sharing reduction program that is projected to save taxpayers $36 billion by using funds to lower plan premiums rather than funneling them directly to insurers as premium payments.
While this sounds promising, the fact sheet does not address the complexities involved in achieving this goal. This section also discusses kickbacks to Pharmacy Benefit Managers (PBMs) received by large brokerage houses—practices that ultimately raise overall healthcare costs. These arrangements have long been criticized for valid reasons.
The likelihood of reform in this area appears higher, as it impacts middlemen more than pharmaceutical manufacturers directly. On January 22, 2026, the House of Representatives approved the Consolidated Appropriations Act, which includes several healthcare provisions focused primarily on PBM reform. At the time of this publication, the bill has passed the Senate with amendments and is set to return to the House for further consideration.
Holding Big Insurance Companies Accountable
This final topic centers on transparency—an area I strongly support. That said, I have some concerns about certain proposals outlined in the fact sheet.
The plan calls for a “plain English” standard for healthcare communication. While this is a worthwhile goal, it is more challenging than it sounds. As a consultant, I’ve spent significant time trying to explain healthcare terminology in simple terms, and even the basics can be difficult for the average consumer to grasp.
The proposal also calls for insurers to publish claims versus overhead and profit on their websites. However, the Affordable Care Act already requires insurers offering fully insured plans to rebate profits exceeding 20% for individual and small group plans, and 15% for large group plans. This requirement is already monitored, making this proposal feel somewhat redundant.
Where I do see meaningful potential impact is in the proposal to publish claim denial rates. Giving consumers visibility into which insurers deny the most claims would allow them to factor that information into purchasing decisions. Another impactful proposal is requiring hospitals and insurers to publish the actual cost of services.
One of the biggest challenges in controlling healthcare costs is that prices for the same services vary wildly due to undisclosed negotiated rates that differ between insurance carriers. Additionally, private insurers typically pay 2.5 times more than Medicare or Medicaid for hospital services and 1.5 to 2 times more for physician services. Narrowing that gap and allowing consumers to shop based on cost would drive healthcare consumerism and reduce overall spending—especially for individuals using Health Savings Accounts (HSAs) to pay out-of-pocket expenses. The triple tax advantage of HSAs is unmatched.
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Recommendations for Employers
Stay tuned to see which aspects of this plan gain traction and which do not. Employers should lean on their consultants for guidance on the best strategy for their workforce. Mid-market employers (50 to 500 employees) should also evaluate self-funding to determine whether it may be a viable option.
Self-funding can bypass many of the challenges discussed above. By avoiding traditional insurance premiums, employers gain full claims transparency, access to international sourcing for high-cost drugs at significantly lower prices, and greater overall control.