President Donald Trump used his State of the Union address Feb. 24 to plug TrumpRx, criticize the ACA and call out possible Medicaid fraud.
While the president addressed affordability more broadly, immigration, and trade, healthcare took up some of his talking points during the longest-ever State of the Union. NBC News estimated the president spent just under four minutes discussing healthcare, excluding applause, during the 107-minute speech.
Here are six things President Trump said about healthcare and related policies:
1. What’s next after the enhanced ACA subsidy expiration
The failure to extend enhanced ACA subsidies motivated some lawmakers to spotlight affected constituents at the State of the Union. Sen. Tammy Duckworth, D-Ill., who boycotted the address, sent an Illinois man, whose premiums surged after the subsidies lapsed, as her guest.
Amid talks over the future of the subsidies earlier this year, President Trump pitched sending federal healthcare funds directly to consumers, bypassing insurers. A January healthcare policy framework did not provide specifics on how this plan would work.
“Since the passage of the ‘Unaffordable Care Act,’ sometimes referred to as Obamacare, big insurance companies got rich,” President Trump said. “It was meant for the insurance companies, not for the people.”
In January, President Trump floated plans to meet with 14 insurance companies to pressure them on pricing. While no such meeting has been publicly confirmed, five leading health insurance CEOs faced Congress that month, and House Republicans also subpoenaed eight insurers over ACA fraud concerns in February.
In response to the State of the Union, the Federation of American Hospitals echoed critiques of insurers.
“Across the country, American families continue to feel financial pressure, and we agree with the president’s call to lower the cost of healthcare for Americans,” the organization said in a statement shared with Becker’s. “It starts with demanding transparency from big insurers and addressing the rising out-of-pocket costs making it harder and harder for working families to make ends meet.”
2. TrumpRx moves forward
Originally intended to go live in January, the White House launched TrumpRx.gov — a federal direct-to-consumer platform offering discounted prescription drugs — Feb. 5. The administration had been negotiating most-favored-nation pricing agreements with pharmaceutical manufacturers to align U.S. prices for otherwise high-cost drugs with the lowest available in other developed nations. Currently, the website features 43 brand-name medications.
President Trump introduced Catherine Rayner, who he said was the first user of TrumpRx. She accessed an IVF drug on the site with roughly a $3,500 discount, according to the president. Fertility drugs on TrumpRx include Gonal-F, Ovidrel and Cetrotide. Based on the costs presented on the site, the president’s figure is likely based on multiple rounds of a drug.
The president reiterated his call on Congress to codify the most-favored-nation pricing structure into law.
3. ‘The war on fraud’ for Medicaid, a commitment to Medicare
At the end of 2025, the federal government froze all child care payments to Minnesota due to suspected fraud. UnitedHealth Group’s Optum has been auditing the state’s Medicaid program, recently flagging $52.3 million in direct recoveries from high-risk services over the span of 46 months. During his address, President Trump blamed the issues on “Somali pirates who ransacked Minnesota.”
Following concerns coming out of Minnesota, Texas Gov. Greg Abbott has been advocating for his own state to investigate its Medicaid program. President Trump accused California, Massachusetts and Maine of having dire fraud cases. He said Vice President J.D. Vance would lead “the war on fraud.”
Separately, President Trump emphasized a commitment to Medicare and Social Security.
4. Newly imposed tariffs
President Trump said tariffs have been a primary driver of the country’s economic recovery, arguing they could eventually replace income taxes.
“[As] time goes by, I believe the tariffs, paid for by foreign countries, will, like in the past, substantially replace the modern-day system of income tax, taking a great financial burden off the people that I love,” he said.
He issued a temporary 10% global tariff Feb. 20, which took effect Feb. 24 and will remain in effect through July 24. The order came less than 24 hours after the Supreme Court ruled President Trump exceeded his authority by imposing tariffs under the International Emergency Economic Powers Act. In a Feb. 21 Truth Social post, he said he planned to increase the tariffs to 15%. However, no official proclamation has been issued to enact the increase, and he did not confirm it during his speech.
5. New retirement plan
President Trump also pointed to what he described as an improved American workforce, citing that more Americans are working today than ever and that his administration has cut a “record number of job killing regulations.” The unemployment rate was 4.3% in January, up from 4% a year earlier. Job growth slowed in 2025, with U.S. employers adding 181,000 jobs compared to more than 1.4 million in 2024, NPR reported Feb. 24. Healthcare drove the majority of January’s job gains, with 81,900 of the 130,000 jobs added nationwide.
However, President Trump said half of working Americans do not have access to a retirement plan with matching employer contributions. He announced a plan to give Americans without access to a retirement plan the option to enroll in the same type of plan as the one offered to federal government employees, with a contribution match of up to $1,000 annually, beginning in 2027.
6. The One Big Beautiful Bill Act
President Trump pointed to economic improvements under H.R. 1, signed into law July 4, including “no tax on tips, no tax on overtime and no tax on Social Security” for seniors, as well as an increase of the child tax credit from $2,000 to $2,200 per child under 17.
The package is the sixth largest tax cut in U.S. history — not the largest as stated during the speech — according to NPR. While many workers are expected to see somewhat higher take-home pay in 2026, most of the tax savings will go to higher-income households, according to Scott Horsley, NPR’s chief economics correspondent.
The law is also projected to reduce hospital revenue nationwide by $68.5 billion in 2026 and 2027 due to changes to premium subsidies and Medicaid eligibility, according to a Dec. 15 report from Premier.
