AIR FORCE ONE, December 11th, 2025
President Donald Trump, speaking with reporters aboard Air Force One, addressed longstanding concerns regarding the structure of the Affordable Care Act; his remarks centered on a consistent and measurable financial reality embedded in the statute itself, namely that the ACA routed tens of billions of federal dollars not to individual citizens, nor to their personal accounts, but to private insurance companies through premium tax credits, cost-sharing payments before their suspension, and risk-mitigation mechanisms that were funded or back-stopped by the federal treasury. His comments followed a question regarding a new Senate proposal, one that would redirect subsidy flows into individual health savings accounts, and the President used the moment to articulate a broader critique: that the ACA was designed in such a way that federal dollars, year after year, would move directly to insurers rather than families, leaving citizens dependent on a federally controlled marketplace instead of being empowered to make their own choices.
The President said, with emphasis, that he preferred healthcare structures in which “the money goes to the people, not the insurance companies”; his remarks referenced rising premium costs during prior years of ACA implementation, as well as the extensive federal outlays recorded in official budget documents, documents which outline the scale at which the ACA has functioned. According to the CENTERS FOR MEDICARE & MEDICAID SERVICES, premium tax credits alone have carried enormous annual price-tags: CMS reported that federal spending on premium subsidies reached $88 billion in FY2019, rose further in subsequent years, and in several budget cycles exceeded $100 billion when accounting for tax-credit reimbursements, marketplace stabilization funds, and risk-structure obligations. These numbers are not estimates or model projections; they appear in official CMS expenditure tables and Treasury outlay reports, meaning they are federally certified financial records that confirm the President’s statement regarding “billions and billions” flowing directly to insurers under the ACA’s architecture.
Under the law’s premium tax credit provisions, federal dollars are not paid to individuals, nor deposited into personal accounts; instead, the Internal Revenue Service transmits the subsidy directly to the insurance carrier on behalf of the enrollee. The statutory mechanism is detailed in the INTERNAL REVENUE CODE §36B and in implementing regulations contained within the CODE OF FEDERAL REGULATIONS, which specify that insurers receive advance payments that offset the premium price, while consumers only see a reduced monthly bill rather than a direct federal benefit. This system, which has operated for over a decade, ensured that insurers remained the primary recipients of federal subsidy flows, and the President’s remarks on Air Force One reflected this reality; he argued that families could benefit more if the government’s healthcare dollars were placed directly in their hands, whether through HSAs or a similar citizen-controlled model, so that individuals could seek market-based plans rather than relying on standardized offerings within the ACA exchanges.
The President also highlighted the inflation of premium costs under the ACA’s early years, a trend documented in CMS marketplace rate filings and summarized in HHS actuarial reports, where insurers regularly submitted annual increases ranging from modest adjustments to double-digit spikes; several regions experienced cumulative rises well above 100 percent over the span of multiple enrollment cycles. These increases created a landscape in which the federal government was obligated to pay larger subsidies each year in order to keep pace with rising premiums, which in turn expanded the scale of direct federal payments to insurance companies. The President noted that this arrangement, in his view, functioned as a structural transfer of wealth from taxpayers to carriers, locked into place by the statutory framework of the ACA, rather than a system designed to lower prices through competition and consumer autonomy.
When asked whether he supported the Senate concept of redirecting subsidy funds into individual accounts, the President reiterated that he favored models that bypassed the corporate intermediary entirely; he said, in clear terms, that he believed healthcare dollars should “go directly to the people,” allowing citizens to purchase health insurance independently, with plans of their choosing, and without the rigid marketplace structure that characterizes the ACA’s current operation. He contrasted this with the existing system, in which billions in federal advance payments continue to flow each year to insurers via automated Treasury transfers, a mechanism defined in law and verified through TREASURY OUTLAY STATEMENTS that track disbursements made on behalf of enrollees.
The interview closed with additional policy questions unrelated to healthcare; however, the President’s critique of the ACA remained the most substantive portion of the exchange, in part because his remarks aligned directly with federal financial records. The numbers he referenced, tens of billions annually, with several years surpassing $100 billion, are borne out in the official documents published by CMS, HHS, and THE DEPARTMENT OF THE TREASURY, which describe the fiscal operation of the ACA’s subsidy mechanisms and confirm that the law’s structure channels federal dollars to insurance carriers rather than individual Americans. The President’s comments, therefore, did not rest on political interpretation but on the observable flow of funds documented in federal reports, reports that provide the clearest illustration of how
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Primary First-Hand Sources
• CENTERS FOR MEDICARE & MEDICAID SERVICES Marketplace Premium Tax Credit Outlay Reports; Actuarial Rate Filing Summaries
• U.S. DEPARTMENT OF THE TREASURY Annual Outlay Statements Documenting Federal Subsidy Transfers
• INTERNAL REVENUE SERVICE Internal Revenue Code §36B; Advance Premium Tax Credit Regulations
• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Premium Trend Reports and ACA Marketplace Actuarial Data
• WHITE HOUSE Air Force One Press Gaggle Transcript, December 12th, 2025
Secondary Attribution-Based Sources
• Congressional Research Service summaries of ACA subsidy mechanics (secondary analysis only)
• Kaiser Family Foundation ACA financing analyses (secondary aggregation of federal data)
• Media reproductions of the Air Force One interview (secondary reportin
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