目前关于医疗保险补贴的辩论未见平息，特朗普建议直接将补贴资金返还给民众，而不是“补贴大型保险公司”。与此同时，国会共和党人在迅速推进该提案，但如果直接实施，可能扰乱保险市场。在医疗支出增速高于通胀的背景下，更小规模的改革同样有望带来重大效果。首先，调整医疗保险（Medicare）对医生不同诊疗地点的支付标准，被认为可在十年内为政府节省50亿至1560亿美元。而追求民主党提议的平价医疗法案补贴扩展，十年开支将达到3500亿美元。
除了Medicare以外，商业保险公司也可因定价参照政策节省更多。例如医疗保险优势计划（Medicare Advantage）现已覆盖超过一半受益人，高于2010年的25%。尽管这类计划通常吸引健康投保者且提供更多服务，却导致政府支出增加。相同受益人在该计划下每年支出高出传统Medicare 20%，2025年额外耗资840亿美元。将患者虚假“病重”以获取更高赔付也是支出失控的诱因。根据国会预算局估算，相应改革十年内可节省1240亿到逾1万亿美元。
第三项改革涉及药品福利管理公司（PBMs），其低透明度受批评。二十多个相关法案曾被提出，通过提高透明度，雇主有机会从中获得更好的药价。虽然总体节省有限，却能惠及大量美国人。这项改革最为可能实现，2024年透明度法规曾几乎成为法律。相较之下，大型付款方如医院将极力反对其他进一步削减收入的建议；而改革备受欢迎的Medicare Advantage，则面临更高的政治风险。
Healthcare subsidy debates remain heated after the November 12th government shutdown, with Donald Trump proposing that subsidies go directly to people rather than insurance companies. Congressional Republicans are quickly advancing this plan, but it risks destabilizing insurance markets. Alternatively, targeted reforms could curb healthcare cost growth, which is outpacing inflation. One option is equalizing Medicare payments by location, potentially saving $5–156 billion over ten years. In comparison, maintaining expanded Affordable Care Act subsidies would cost $350 billion over a decade.
Beyond Medicare, commercial insurers could also save more by referencing Medicare policies. Medicare Advantage plans now cover over half of beneficiaries (up from one-quarter in 2010) but cost the government more: insuring the same patient through Advantage is 20% pricier, resulting in $84 billion extra spending in 2025 alone. Insurers are incentivized to make enrollees appear sicker to receive higher payments. According to the Congressional Budget Office, reforms could save from $124 billion to over $1 trillion in ten years, depending on their scope.
The third area for reform centers on pharmacy benefit managers (PBMs), criticized for lacking transparency and keeping too much of negotiated discounts. Nearly two dozen bills have targeted PBM reforms, with lawmakers hoping greater transparency will let employers negotiate better drug prices. While overall savings would be modest, the benefits would reach many Americans. This transparency reform is most likely to succeed—almost becoming law in 2024. By contrast, hospitals and other major stakeholders will likely resist further revenue reductions, and changing the popular Medicare Advantage program carries greater political risk for lawmakers.