Trump Targets Health Insurers, Vows to "Send Money Directly Back to the People"

President Donald Trump has shifted to a populist critique of health insurers, blaming them for rising health care costs as he seeks to blunt Democratic criticism that Republicans have done too little to keep care affordable.

Pressure over ACA subsidies

Democrats are pressing Congress for a quick vote to extend enhanced Affordable Care Act (ACA) premium tax credits that are due to expire at year-end. Trump has reportedly considered a two-year extension paired with Republican-favored reforms but delayed publicly unveiling a plan amid pushback from members of his party.

Reframing the debate

Whether or not leaders reach a deal, Democrats have used the government shutdown to press Republicans on health care. Trump and his allies are attempting to reframe the conversation by casting insurers as a principal cause of rising costs — a message that taps into public frustration with medical bills.

"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.

What the polls say

Recent polling finds many Americans blame insurers for medical debt: 63 percent in one survey identified insurers as most responsible, and 76 percent said they would prefer a different insurance approach that keeps the unemployed or self-employed covered. A KFF Health Tracking Poll also found broad support for extending the enhanced ACA premium tax credits, with roughly 74 percent favoring an extension rather than allowing them to lapse.

Industry responses and context

The health insurance trade group AHIP points out that federal rules cap health plans' profit and administrative cost rates and cites data from the National Association of Insurance Commissioners showing health plans' profit margins fell to about 0.8 percent last year. By contrast, industry analyses such as the Campaign for Sustainable Rx Pricing report that pharmaceutical companies' average net income margins hovered around 23 percent from 2017–2023.

"Premiums reflect the underlying cost of care," AHIP spokesperson Chris Bond said. "Upwards of 24 cents of each dollar goes toward prescription drugs and more than 40 cents goes toward hospital care. Those rising costs are what drive premiums."

Pharmaceutical trade group PhRMA emphasized investments and commitments to lower drug costs while continuing research and development. "Biopharmaceutical companies are stepping up with major commitments — including substantial U.S. manufacturing and R&D investments — to help make medicines more affordable and accessible," said PhRMA spokesperson Chanse Jones.

Political implications

Strategists and pollsters say the political impact of Trump’s messaging will depend on whether Republicans can present a credible alternative that visibly reduces out-of-pocket costs for patients. Robert Cahaly, chief pollster at the Trafalgar Group, argued that framing and a tangible proposal could make the attack on insurers politically effective.

Health policy experts note that voters tend to care most about what they personally pay at the point of care. "The average patient wants to know what it's going to cost me — what will come directly out of my pocket," said Joe Antos, senior fellow emeritus at the American Enterprise Institute. He added that naming a culprit matters less than delivering real reductions in patients' bills.

This debate — over who bears responsibility for rising costs and which policy fixes will actually lower out-of-pocket spending — is likely to remain central as both parties prepare their messages for voters.