US President Donald Trump has laid out plans to overhaul ACA funding and shake up the health insurance industry, using his 2026 State of the Union address to call for an end to direct federal payments to insurers and a shift toward putting the money in consumers' hands.
In what was the longest State of the Union speech on record, Trump took aim at the Affordable Care Act, describing it as a vehicle that enriched large health insurance companies at the public's expense.
He said their stock prices had climbed by as much as 1,700%, and called for giving funds "directly to the people, so they can buy their own health care."
That figure, however, draws on individual company performance rather than an industry-wide average. The Paragon Health Institute, a conservative-leaning think tank, has previously calculated a weighted average increase of about 1,032% across major insurer stocks from 2010 levels.
PolitiFact placed the broader average closer to 700% by January 2024, though individual companies such as UnitedHealth and Centene did see gains above 1,000% depending on the timeframe used.
Trump also described the government as giving insurers "hundreds and hundreds of billions of dollars a year." Congressional Budget Office estimates from 2023 put ACA exchange-specific premium tax credits at roughly $92 billion – funds that flow through insurers but function as subsidies to reduce consumer premiums.
On prescription drugs, Trump said his most-favored-nation agreements had moved American prices from the highest in the world to the lowest, and urged Congress to codify the program.
However, a 2024 study by the RAND Corporation found US drug prices still roughly 2.78 times the average of comparable nations. The administration's TrumpRx platform has delivered steep discounts on select medications for cash-paying patients, though data from 46brooklyn Research showed manufacturers raised list prices on nearly 950 brand-name drugs in January 2026.
The address made no reference to property insurance, wildfire risk, or the National Flood Insurance Program – areas that have drawn sustained attention from insurers and regulators.
A US Treasury Department report has previously described homeowners insurance as increasingly costly and difficult to obtain as climate-related losses mount, with national average policy costs rising an estimated 30-40% over the past five years.
The January 2025 Los Angeles wildfires, which destroyed some 11,000 homes and generated more than $22 billion in insurer payouts, further intensified scrutiny on coverage availability.
The NFIP, which covers nearly 4.6 million policies representing about $1.3 trillion in exposure, faces a reauthorization deadline of September 30, 2026. The American Property Casualty Insurance Association has pushed for a minimum seven-year extension to replace the program's pattern of short-term renewals - 35 since the end of fiscal year 2017.
Trump reiterated his commitment to protecting Social Security, Medicare, and Medicaid, and announced plans to extend employer-matched retirement plans to workers who currently lack access.
