President Donald Trump’s new healthcare policy framework, released Jan. 15, may seem far removed from immigration law or international nurse recruitment. But for U.S. hospitals, long-term care facilities, and healthcare employers that depend on foreign-trained nurses to stabilize staffing, this proposal could shape reimbursement, operational costs, and ultimately hiring strategies for years to come.
At VisaMadeEZ, an immigration law firm that specializes in helping healthcare organizations hire international nurses, we closely track health policy trends that affect our clients’ workforce planning. Below is a plain-language breakdown of the proposal and what it might mean for nurse staffing, international recruitment, and immigration planning.
Overview: What the “Great Healthcare Plan” Proposes
President Trump’s “Great Healthcare Plan” is a broad, high-level framework rather than a fully detailed bill. It:
- Codifies voluntary drug pricing agreements with major pharmaceutical companies
- Shifts financial support from enhanced Affordable Care Act (ACA) subsidies toward direct payments to individuals
- Expands price transparency requirements for insurers and healthcare providers
Many of the implementation details and enforcement mechanisms are not yet defined. However, if enacted, this framework could influence:
- Hospital and health system margins
- Insurance coverage patterns for patients
- Drug costs for high-utilization populations, including elderly and chronically ill patients
- Strategic decisions around hiring, including whether U.S. healthcare employers expand or scale back recruitment of international nurses
For healthcare organizations working with immigration attorneys to sponsor foreign-trained nurses on immigrant visas, these shifts may affect timelines, budgets, and long-term staffing models.
1. Drug Pricing: Lower Costs, Higher Complexity
Most-Favored-Nation Drug Pricing Model
The plan would formalize the administration’s “most-favored-nation” (MFN) drug pricing model. Under this model, U.S. drug prices would be tied to the lowest prices paid in comparable high-income countries.
Key elements include:
- Preservation of existing HHS and CMS voluntary pricing agreements with major drugmakers
- 16 of the 17 largest pharmaceutical companies including Pfizer, Eli Lilly, and Sanofi have already signed such agreements
- Regeneron remains the only major manufacturer that has not yet entered into a deal
These agreements apply to drugs used to treat:
- Cancer
- Type 2 diabetes
- Rheumatoid arthritis
- HIV
- Hepatitis B and C
- Asthma
For hospitals and outpatient clinics, lower drug acquisition costs may gradually ease financial pressure on pharmacy budgets, especially for high-cost specialty medications. This can indirectly influence staffing, including the ability to maintain competitive wages for U.S. nurses and international nurses alike.
TrumpRx: Direct-to-Consumer Discounted Medications
The framework also introduces TrumpRx, a federal direct-to-consumer online platform scheduled to launch later this month. Under the proposal:
- Many of the discounted medications covered by MFN pricing would be available through TrumpRx
- The platform would feature notable discounts on insulin and GLP‑1 drugs used for diabetes and obesity (e.g., Ozempic, Wegovy, Mounjaro, Zepbound)
For healthcare organizations, lower patient out‑of‑pocket drug costs could:
- Improve medication adherence
- Reduce emergency room visits and readmissions
- Potentially stabilize patient volumes and reimbursements, which matter when planning long-term nurse hiring and international recruitment campaigns
Medicaid and Medicare Implications
Under the proposal:
- Drugmakers would sell medications to Medicaid at MFN prices
- Eli Lilly and Novo Nordisk have agreed to sell Ozempic, Wegovy, Mounjaro, and Zepbound to Medicare through CMS’ voluntary BALANCE model
The BALANCE model is designed to:
- Expand access to GLP‑1 drugs
- Pair medications with no-cost lifestyle and behavioral programs
These changes coincide with Medicare’s first wave of negotiated drug prices under the Inflation Reduction Act, which began capping costs for 10 high-expenditure Part D drugs on Jan. 1.
From a workforce perspective, better controlled chronic disease in the Medicare population may:
- Reduce avoidable hospital utilization over time
- Shift demand toward outpatient and community-based care
- Drive the need for nurses with chronic disease management skills including international registered nurses recruited for long-term care, home health, and ambulatory settings
2. Insurance Costs: Direct Payments Instead of Enhanced ACA Subsidies
Where this framework becomes especially relevant for healthcare organizations and immigration planning is in its treatment of ACA subsidies and insurance design.
Replacing ACA Subsidy Payments to Insurers
The proposal would:
- End direct ACA subsidy payments to insurers
- Redirect funds to eligible Americans via direct payments to purchase their own coverage
However, the framework does not specify:
- How these payments would be delivered
- Whether the plans purchased must comply with existing ACA standards
- If protections for people with preexisting conditions would be preserved
For hospitals, especially those serving large populations of lower-income or underinsured patients, this uncertainty could:
- Affect uncompensated care levels
- Create volatility in payer mix and collection rates
- Influence budget flexibility for sponsoring international nurses on immigrant visas or temporary work visas
Health Savings Accounts (HSAs) as an Alternative
Some Republicans are advocating health savings accounts (HSAs) as a substitute for extending enhanced ACA subsidies, which expired at the end of 2025. In the Senate:
- A bipartisan draft bill would extend ACA subsidies for two years
- In year two, it would introduce an HSA option
That legislation is still in early stages and is not expected to be ready until late January.
If HSAs become a more dominant coverage vehicle:
- Patients might face higher deductibles but more price sensitivity
- Providers could see increased pressure to display prices and streamline billing
- Healthcare organizations may need to invest more in administrative systems potentially squeezing operating budgets that fund nurse recruitment, including international nurse sponsorships
Cost-Sharing Reductions (CSRs) and “Silver Loading”
The plan would also restore federal funding for cost-sharing reductions (CSRs) payments that help lower-income ACA enrollees with deductibles and copays.
Since CSR payments were halted in 2017, insurers responded with “silver loading,” essentially shifting CSR costs into higher silver-plan premiums. The new proposal:
- Would reinstate CSR funding
- Claims it would save at least $36 billion
- Projects that premiums for the most common ACA plans could fall by more than 10%
Reversing silver loading would unwind a Trump-era policy from the first term and may stabilize some parts of the individual market. More consistent coverage could translate into:
- Fewer uninsured patients
- More predictable reimbursement streams
- A more solid financial base for hospitals planning multiyear international nurse recruitment and immigration strategies
New Insurance Transparency Requirements
Three major transparency mandates would apply to insurers:
1. Plain-language benefit and rate comparisons
- Insurers would need to publish easy-to-understand summaries of coverage options and pricing.
2. Reporting on claim denials and wait times
- Public data on denial rates and average wait times for routine care.
3. Revenue allocation disclosure
- Insurers would show what percentage of premium revenues goes to claims versus administrative overhead and profit.
A fourth provision would restrict pharmacy benefit manager (PBM) kickbacks to brokers.
In the broader context, these rules would increase public scrutiny of payers. For healthcare organizations, this level of transparency may:
- Drive patients to plans with better access and lower administrative friction
- Reduce delays in authorizations and reimbursements over time
- Strengthen financial planning for long-term staffing including determining how many foreign-trained nurses to sponsor through employment-based green cards or other visa categories
ACA Marketplace Enrollment and Political Context
Marketplace enrollment has dropped to 22.8 million for 2026, based on preliminary CMS figures. Meanwhile:
- The House passed a three-year ACA subsidy extension Jan. 8
- The bill has stalled in the Senate
- President Trump has indicated he may veto any subsidy extension
At the same time, congressional scrutiny of insurers is intensifying. CEOs from UnitedHealth, CVS Health, Elevance, Cigna, and Ascendiun are scheduled to testify at dual House hearings on Jan. 22 before the Energy and Commerce and Ways and Means committees. The President has also stated that he plans to meet with 14 insurers about industry profits.
For healthcare employers already sponsoring international nurses or considering launching an immigration program this policy volatility underscores the importance of:
- Building flexible workforce models
- Partnering with an immigration law firm that understands both healthcare finance dynamics and nurse visa processes
- Planning recruitment on a 3–5 year horizon rather than reacting to single-year insurance swings
3. Price Transparency: Posting Prices for Any Provider Taking Medicare or Medicaid
The plan’s transparency provisions extend beyond insurers to healthcare providers.
Expanded Transparency Obligations for Providers
Any healthcare provider or insurer that accepts Medicare or Medicaid would be required to:
- Prominently post their pricing and fees at their place of business
This builds on existing federal rules:
- Hospital transparency rules became effective Jan. 1, 2021
- Insurer transparency requirements began July 1, 2022
Since the hospital price transparency rules took effect:
- 27 hospitals have been fined
- Fines have ranged from $32,301 (Southeast Regional Medical Center, Kentwood, La.) to $979,000 (UF Health North, Jacksonville, Fla.)
- No insurers have yet been fined for transparency violations, despite documented gaps in published data
For hospital systems sponsoring international nurses, noncompliance with transparency requirements can mean:
- Significant civil monetary penalties
- Reputational damage
- Diversion of funds away from clinical staffing and recruitment efforts
Upcoming 2026 Transparency Updates
Two major updates are scheduled for 2026, affecting both payers and hospitals.
Payer Machine-Readable Files (MRFs) – Schema 2.
Starting Feb. 2, 2026, payers must:
- Update their machine-readable files to the schema 2. format
- Add clearer context to pricing data
- Reduce file sizes and improve usability
This change is aimed at making data more usable for regulators, patients, and third-party tools that compare health costs.
Hospital MRF Changes – Accountability and Detail
Beginning *April 1, 2026*, hospitals will see changes in three spheres:
1. Attestation and Executive Accountability
- Stronger requirements for hospital leadership to attest to file accuracy and completeness.
2. Percentile Allowed Amounts and Counts
- More detailed reporting of allowed amounts and their percentile distribution, plus counts of claims at those levels.
3. National Provider Identifier (NPI) Reporting
- Additional reporting obligations tied to NPIs, improving traceability and comparability across facilities.
CMS has also proposed updates that would:
- Require insurers to simplify how they organize pricing data
- Reduce reporting frequency from monthly to quarterly
- Strengthen price comparison tools so consumers can more easily find cost information
For healthcare employers, this transparency ecosystem could:
- Increase competition on price and quality
- Drive changes in patient volume and payer mix
- Highlight facilities that deliver value a key recruiting advantage when attracting international nurses who want stable, reputable employers
What This Means for Healthcare Organizations Hiring International Nurses
While President Trump’s healthcare framework is not an immigration bill, its ripple effects will be felt in hospital finance, workforce planning, and long-term recruitment strategy. For U.S. healthcare employers reliant on international nurse staffing, several themes stand out:
1. Financial Predictability Matters for Immigration Strategy
Changes in drug pricing, ACA subsidies, and reimbursement patterns affect hospital margins. Stable or improving margins make it easier to commit to multi-year international recruitment programs and sponsorship of registered nurses through immigrant visas.
2. Transparency and Compliance Are Non-Negotiable
With higher expectations around price transparency and executive accountability, noncompliance is costly. Healthcare organizations that invest in compliance are better positioned to allocate resources confidently to hire international nurses and maintain competitive compensation packages for both foreign and U.S. nurses.
3. Chronic Disease Management Will Drive Demand
If lower drug prices and programs like BALANCE improve management of diabetes, obesity, and other chronic diseases, care may shift toward outpatient and community settings. This could mean increasing demand for nurses with chronic disease management expertise a role many international nurses are well-prepared to fill.
4. Policy Volatility Requires Long-Term Workforce Planning
Uncertainty around ACA subsidies, HSAs, and private insurance oversight makes short-term budgeting more complex. Employers that plan nurse staffing and immigration strategies over a 3–5+ year horizon will be better equipped to weather policy swings.
How VisaMadeEZ Supports Healthcare Employers Amid Policy Change
At VisaMadeEZ, we focus exclusively on immigration services for healthcare organizations hiring international nurses. We understand that health policy changes even those that don’t mention immigration directly influence:
- How many nurses you can afford to sponsor
- Which units or facilities need international nurses the most
- How quickly you need to move candidates through the immigration pipeline
Our services include:
- Strategic workforce and immigration planning aligned with projected reimbursement trends
- Employment-based green card petitions for international registered nurses
- Visa processing, compliance, and onboarding guidance tailored to hospitals, skilled nursing facilities, and other healthcare employers
- Ongoing legal support as federal healthcare and immigration policies evolve
Planning Your International Nurse Recruitment in a Changing Policy Environment
If your organization is:
- Struggling with persistent nurse shortages
- Considering launching or expanding an international nurse recruitment program
- Unsure how policy changes in drug pricing, ACA subsidies, and transparency rules might affect your staffing plans
VisaMadeEZ can help you build a sustainable, compliant, and cost-effective international nurse hiring strategy.
To speak with an attorney who understands both immigration law and the realities of healthcare finance, contact VisaMadeEZ today. Together, we can align your international nurse recruitment with the emerging healthcare policy landscape so your organization stays staffed, compliant, and ready to serve patients, no matter how the rules change.
