Two leading Republican senators have introduced yet another plan to address the expiry of the Affordable Care Act's (ACA's) enhanced subsidies.
Senate Finance Committee Chair Mike Crapo, R-Idaho, and Health, Education, Labor and Pensions Committee Chair Bill Cassidy, M.D., R-La., unveiled late Monday a package that aims to bypass the enhanced premium tax credits by sending money directly to members via a health savings account (HSA).
Under the bill, individuals who sign up for a bronze or catastrophic plan on the exchanges that's paired with an HSA will receive a contribution from the Centers for Medicare & Medicaid Services. For individuals making up to 700% of the federal poverty level, they will receive $1,000 if aged 18 to 49 and $1,500 if they're between the ages of 50 and 64.
The bill would also bar these HSA funds from being used for abortion or gender transition services, according to a one-pager (PDF) from the legislators.
Crapo and Cassidy said in an announcement that the bill follows the Working Families Tax Cuts Act (also known as the One Big Beautiful Bill Act), which was signed into law in July and expanded the ability to pair HSAs with more health plans, including exchange plans.
The pair is billing the legislation as a way to put more power in the hands of patients and turning up the heat on the populist rhetoric against insurance companies.
"Instead of 100% of this money going to insurance companies, let’s give it to patients," Cassidy said in the announcement. "By giving them an account that they control, we give them the power. We make healthcare affordable again."
The president made similar statements dinging health plans Monday, per Reuters. President Donald Trump previously said on his social media platform Truth Social that he would only support a healthcare plan that sends money directly to patients instead of the "big, fat, rich insurance companies" that have "ripped off America long enough."
The White House appeared to reverse course on this stance as it prepared to release its own healthcare plan in late November, which would likely have extended the subsidies with additional guardrails in place. However, the plan was delayed following pushback from Republicans in Congress.
In addition to the push for HSAs, the Cassidy-Crapo bill would also fund cost-sharing reduction payments in a bid to lower premiums. HSA funds can be used to buy medical services but generally cannot be applied directly to premiums.
The bill would also expand access to catastrophic coverage as a way to lower costs, though critics have warned that these plans carry high deductibles and cost-sharing for members. KFF said the annual deductible for an individual in one of these plans for 2026 is $10,600, and these plans will cover just three primary care visits before enrollees need to meet that deductible.
The legislative package also includes provisions that aim to prevent illegal immigrants from enrolling in Medicaid by implementing new citizenship checks. It would prevent taxpayer funding from covering gender transition services under Medicaid and excludes this care as an essential health benefit under the ACA.
“Giving billions of taxpayer dollars to insurers is not working to reduce health insurance premiums for patients,” said Crapo. “We need to give Americans more control over their own healthcare decisions."
Many people who had qualified for the enhanced premium tax credits were met with sticker shock on the exchanges in learning they were set to expire at the end of this year. People have less than a week to sign up on the marketplaces for plans that take effect Jan. 1.
Democrats held out during the government shutdown over the subsidies and reopened federal operations with the promise of a vote on an extension. That is set to be held Thursday, though the Dems' plan for a three-year "clean" extension is unlikely to pass.