Elaine Parker: Three healthcare reform ideas for Congress

As 2025 winds down, enhanced Obamacare subsidies are finally set to expire. Yet, congressional Democrats are fighting tooth and nail to preserve this temporary, pandemic-era giveaway that should have sunset years ago. The scheme not only hides the true cost of care for millions of Americans but undermines genuine efforts to reform our broken healthcare system with choice, transparency, and competition.

If conservatives are resolute, this could be the rare exception to Ronald Reagan’s adage that “nothing lasts longer than a temporary government program.” For the sake of families wrestling with high premiums, small businesses struggling to sponsor coverage for employees, and patients who are priced out of medicines at the pharmacy counter, my fingers are crossed.

In addition to letting enhanced Obamacare subsidies expire, here are three other healthcare reform ideas for lawmakers to consider.

One, give patients more freedom and flexibility on how to use Health Savings Accounts (HSAs). It’s a financial tool that allows Americans—and their employers—to set aside pre-tax money for qualified health expenses, such as out-of-pocket costs for doctor visits and lab work. Republicans made progress towards broadening HSA applications earlier this year by permitting funds to pay for direct primary care, but that should just be the start.

To give patients even more control over their healthcare dollars, Congress should let families use HSA money to pay down health insurance premiums, especially for plans on the Obamacare exchanges. Existing government health subsidies should then seed—or replenish—individual HSAs instead of paying big insurance companies directly. That way, subsidy recipients see the true cost of health plans and can more easily compare prices to get the best value.

President Trump is already on board with the idea. Policymakers just need to put pen to paper to flesh out the details.

Two, lawmakers should loosen government regulations so small businesses can more easily take advantage of Association Health Plans (AHPs). Giving small businesses the autonomy to band together when shopping for health plans will unlock the same economies of scale and bargaining power that Fortune 500 companies enjoy. With more people in a plan, insurers can spread risk more efficiently and cheaper rates can be negotiated.

President Trump sought to give small businesses this kind of relief during his first term via Department of Labor rulemaking. Unfortunately, those efforts were ultimately bogged down in the courts by Democrats, preventing the reforms from taking hold. But where executive action fell short, Congress can succeed in implementing lasting reform that significantly lowers health plan costs for Main Street.

Three, lawmakers can foster greater price transparency and curb adverse incentives within the drug supply chain. Right now, Pharmacy Benefit Managers (PBMs)—which are the middlemen between manufacturers and the patient market—are encouraged to push more expensive medicines to consumers. Why? Because PBM profits are based on drug prices rather than the number of patients helped or units sold.

Passing legislation to delink PBM revenue from a prescription drug’s price tag will realign market incentives to benefit patients. For example, a lower cost generic product could be just as good—or even better—in certain medical situations than the expensive brand name medicine. Giving patients the opportunity to access the most effective medicine at the best price should be a priority over middlemen cash grabs.

As the fight over enhanced Obamacare subsidies intensifies, lawmakers should target the root causes of America’s broken healthcare system rather than just treating the symptoms. Allowing temporary government entitlements to expire may be a bitter pill to swallow now, but it will clear a path for smart reforms that will bring lasting relief for families and small businesses.

Elaine Parker is the president of the Job Creators Network Foundation.