Health care affordability has now become voters’ number one domestic concern. And with good reason. Health care costs are going through the roof.
AFP polling shows voters are demanding relief.
But that’s only half the story. You wouldn’t know it from the news, but President Trump and congressional Republicans enacted 27 health care wins this past year – incremental reforms that will help make health care more affordable and accessible for millions of Americans.
The Health Care Affordability Crisis
American health care has reached a tipping point. Consider:
- Health insurance prices have tripled in real terms since 2000.
- Health care now consumes nearly 20 percent of household income.
- Polls show nearly half of U.S. adults find it difficult to afford health care.
- One in four say they or a family member had problems paying for health care in the past year, and a similar number said they had to put off needed care.
Is all this extra money buying us better access? No, access to doctors is shrinking, wait times are getting longer, and insurers are refusing to pay for covered services. Claim-denial rates have surged tenfold since 2014.
No wonder a majority of Americans say our health care system is in crisis or has major problems.
The 27 GOP Health Care Wins
If there was ever a time for action, it’s now.
Thankfully, Congress has taken notice.
If you’ve never heard of the following 27 wins, it’s no surprise. “GOP Reforming Health Care” is not a headline you’re likely to see these days. It doesn’t fit the dominant press narrative, which holds that “Republicans have no plan” and are afraid of the issue. But 27 provisions of the Working Families Tax Cut of 2025 (WFTC) and the Consolidated Appropriations Act of 2026 (CAA) beg to say otherwise.
Let’s look at the details.
Expanded Health Savings Accounts.
The WFTC:
1. Allowed 7 to 10 million Americans to have a tax-free Health Savings Account. (WFTC §71307)
This reform, which benefits people who select a bronze or copper (“catastrophic”) plan in the Affordable Care Act (ACA) marketplace, will help drive down medical prices by empowering consumers to shop for value.
An HSA is a powerful financial tool that serves as a personally owned and controlled “medical wallet.” Thanks to generous tax treatment, it gives you a 25 percent discount, on average, on every medical purchase. Think of it as Venmo or Apple Pay for your health care.
Having an HSA maximizes your choice and control over your health care decisions, with no insurance-company hassle. In fact, patients can use their HSA to buy items, services, and procedures their insurance doesn’t cover – or refuses to pay for.
Sadly, right now no more than about 20 percent of Americans have access to an HSA. But this reform takes a first, important step toward the goal of making HSAs available to all Americans.
Expanded Direct Access to Doctors.
The WFTC:
2. Made Direct Primary Care (DPC) an HSA-compatible expense. (WFTC §71308)
3. Made DPC fees HSA-eligible. (WFTC §71308)
DPC is a monthly subscription that gives you unparalleled access to your trusted doctors, for one low fee, with no hidden or extra charges – and no insurance-company meddling. Having a DPC subscription gives you guaranteed access to same-day and next-day doctor appointments and round-the-clock freedom to talk to your doctor via email, text, and video. DPC doctors spend four times as much time with their patients as do traditional, insurance-based doctors. DPC likely improves health outcomes by giving patients a “medical home” with direct access to a doctor they trust.
Thanks to the WFTC, all of today’s 75 million HSA users now enjoy a tax break for insurance-free access to the doctors of their choice. Everyone should have this option.
Promoted Hospital Competition While Providing Relief for Rural Hospitals.
4. Created a new $10-billion-a-year fund, for five years, to helps states protect vulnerable hospitals and clinics. (WFTC §71401)
Not only does the GOP’s new Rural Hospital Transformation Fund (RHTF) help ensure health care access in remote and underserved areas, it’s also a valuable tool for driving state-level reforms. In order to receive a full allotment of money from the Fund, a state must agree to reform its health care markets to promote choice and competition, for example, by expanding telehealth access and repealing anticompetitive certificate of need (CON) laws, which artificially restrict the supply of hospitals, MRI machines, etc.
5. Enacted the Transparency in Billing Act, which requires a separate identification number and attestation for each off-campus hospital outpatient department (HOPD) of a medical provider under Medicare. (CAA §6225)
This provision establishes an essential prerequisite for site-neutral payment reform in Medicare. Site neutral payment is a broadly supported proposal to move Medicare to a payment policy of “same service, same price.” Today, Medicare wastefully pays providers differently for a service based only on the kind of facility in which the care was delivered. Hospital corporations have exploited this differential to maximize profits, leading to intense market consolidation and higher prices.
Moving to site neutrality will create a level playing field on which hospitals and doctors are forced to compete based solely on price, quality, and convenience. Once enacted, site-neutrality will reduce out-of-pocket costs for seniors and the disabled by an estimated $100 billion, and save taxpayers $157 billion, over ten years. And the reform will benefit all Americans because private insurers often pay providers as a percentage of what Medicare pays.
Expand Telehealth Access.
Telehealth saves lives and money by giving people better access to trusted doctors, with less risk of infection.
6. Expanded access to telehealth by permanently allowing HSA-qualified health plans to cover 100 percent of the cost of telehealth. (WFTC § 71306)
7. Extended, for two years, Medicare’s pandemic-era telehealth flexibilities, preserving broad telehealth Access for 65 million elderly and disabled seniors on Medicare. (CAA §6209)
The pandemic telehealth flexibilities waive geographic telehealth limitations, allow audio-only telehealth and telehealth from the patient’s home, delay in-person visit requirements for mental health services, allow telehealth when recertifying eligibility for hospice care, and make telehealth services an allowable expense for Federally Qualified Health Centers and Rural Health Clinics. Continuing these flexibilities is good for patients.
8. Improved telehealth for 25 million Americans with limited English proficiency and those with audio-visual and other medical disabilities. (CAA §6213)
This reform will help address the problem of health care miscommunication, which cost nearly 2,000 lives and $1.7 billion in hospital costs between 2009 and 2013.
Facilitated Care for Children, Seniors, and the Disabled.
9. Facilitated medical care across state lines in Medicaid, benefitting up to 37 million children, including two million with complex medical conditions, by streamlining the enrollment process for eligible out-of-state pediatric care providers. (CAA §6101)
This reform will improve health outcomes for lower-income children enrolled in Medicaid, including those with complex medical conditions, by removing regulatory barriers to care. Children with complex medical conditions often need specialized treatments that may not be available in-state.
10. Continued the Hospital Care at Home experiment for Medicare patients, benefitting up to 65 million elderly and disable Americans, by extending, for five years, Medicare’s pandemic-era acute hospital care at home waiver flexibilities. (CAA §6210)
This pilot program enables patients to receive an inpatient hospital level of medical care in the comfort of their own home and to use telehealth as part of their care.
Cracked Down on Medicaid Fraud.
Health care fraud is out of control, wasting taxpayer dollars and denying scarce resources to the needy. The WFTC instituted a series of reforms to restore program integrity in the massive, troubled Medicaid program:
11. Prohibited Medicaid for undocumented persons. (WFTC §71109)
12. Required able-bodied adults to work for their Medicare benefits. (WFTC §71119)
13. Required more frequent Medicaid eligibility redeterminations, ensuring resources are preserved for those who really need them. (WFTC §71107)
14. Suspended Biden’s costly nursing home staffing mandate rule, which would have driven up already-too-high nursing home prices. (WFTC §71111)
15. Blocked the Biden rule that auto-enrolls elderly enrollees in extra subsidies. (WFTC §71101)
16. Blocked the Biden rule that “streamlines” enrollment in Medicaid, CHIP, and the Basic Health Program, a rule intended to enroll as many people as possible, even those who don’t need the help. (WFTC §71102)
17. Improved screening for ineligible enrollees in Medicaid. (WFTC §71104)
18. Improved screening for ineligible physicians in Medicaid. (WFTC §71105)
19. Reduced the amount of erroneous Medicaid payments that HHS may forgive. (WFTC §71106)
20. Capped “state-directed” provider payment rates at the Medicare rate in Medicaid expansion states, ending wasteful overpayments to hospital corporations. (WFTC §71116)
21. Reduced the maximum allowable provider-tax rate, shrinking a major state money-laundering scheme. (WFTC §71115, §71117)
22. Sunset Biden’s special “enhanced” Medicaid payments to states, which tried to bribe states into expanding their Medicaid programs to cover able-bodied adults. (WFTC §71114)
By shutting out scammers and fraudsters, the WFTC is freeing up Medicaid dollars for the truly vulnerable.
Cracked Down on ACA Enrollment Fraud.
The WFTC also shored up program integrity in the troubled Affordable Care Act (“Obamacare”) insurance-subsidy program, saving taxpayers tens of billions:
23. Barred ACA premium tax credits for undocumented persons. (WFTC §71301)
24. Closed a loophole that let legal immigrants enroll who don’t qualify for benefits. (WFTC §71302)
25. Required pre-enrollment eligibility verification for the credit. (WFTC §71303)
26. Disallowed the ACA tax credit during “special enrollment periods,” a loophole created by the Biden administration to put as many Americans as possible on inferior, government-run health care. (WFTC §71304)
27. Required full repayment of excess ACA premium tax credit amounts, ending a costly abuse of our tax dollars actively encouraged by the Biden administration. (WFTC §71305)
Groundbreaking research in 2024 by the Paragon Health Institute uncovered massive enrollment fraud in Obamacare. Their recently updated findings suggest that a quarter of ACA enrollees are not qualified for the benefits they’re receiving.
How to Build on These Wins
Together, the 27 wins constitute “one big, beautiful win” for patients and taxpayers. (Sadly, congressional Democrats voted against all but a handful of them.) But these gains are just a start. To really reform our broken system, we need to go further. Congress should:
Empower Consumers
- Make HSAs available to everyone.
- Expand Direct Primary Care to include specialists.
- Reform government health care programs to fund patients, not insurance companies.
(Most federal health insurance subsidies go straight to insurance companies, not patients.)
Make Health Insurance Affordable Again
- Legalize Association Health Plans. (Think of getting discount-price health insurance through your Costco or Amazon membership.)
- Codify and strengthen Short Term Health Plans, which can be 50 to 80 percent less expensive than an Obamacare plan.
- Codify and Strengthen workplace CHOICE Arrangements (ICHRAs), which enable you to receive tax-free money from your employer to buy affordable, personally tailored insurance that stays with you from job to job.
Make Health Care Affordable Again
- Eliminate government mandates and policies that stifle competition and drive up prices.
The Choice We Face
The current health care “system” is broken. Reform is urgent.
But we face a choice. Some in Washington are pushing ideas like expanding Obamacare and eliminating private insurance altogether (“Medicare for All”).
Do we want more of the same? A health care system with even fewer options, even longer wait times, and even more bureaucratic rationing like they have in Canada, Britain, and other “single payer” systems?
Or do we want a competitive free-market system, with transparent prices, anytime access to your favorite doctors, affordable insurance that’s there when you need it, and a tax-free health savings account – a “medical wallet” – that gives you access to the drugs, devices, and procedures you want, when you want them?
We’re all used to the traditional, insurance-centric system where we never see a price upfront, we expect our insurance to cover pretty much everything, and we don’t feel a need to shop around. It’s a comforting model. But it’s broken. It’s failing us. And families are suffering.
The good news is the same forces that are driving costs through the roof – soaring premiums, sky-high deductibles – are also fueling a consumer revolution that, if we let it blossom, will make today’s “system” look like the Stone Age.
People are demanding – and the market is delivering – new ways to access care and new tools that make shopping for health care as convenient and satisfying as shopping at Amazon.
- New apps are appearing daily that show you the cost of a procedure upfront, with no surprises.
- New retail websites like costplusdrugs.com and trumprx.gov are letting you buy prescription drugs direct from the manufacturer at a huge discount.
- New facilities like the Surgery Center of Oklahoma are offering fully transparent, upfront, all-in pricing – often at far lower prices than their competitors.
- DPC and HSAs are helping people take control of the routine expenses that represent 90 percent of the average family’s annual health care interactions.
But this budding new, better health care world won’t fully deliver if we fail to remove the barriers that are keeping people trapped in the current, broken system.
These 27 health care wins represent one small step toward that better world. Do you support them? Do you want Congress to deliver even more affordability? If so, let your elected representatives know. Tell them: “We want real, market-based health care affordability — and we want it NOW.”
To learn more about AFP’s Personal Option plan to give every American reliable, hassle-free health care you can afford, visit PersonalOption.com.
Dean Clancy is a Senior Health Care Policy Fellow at Americans for Prosperity.
