With enhanced Affordable Care Act tax credits set to expire Dec. 31, Sen. Bill Cassidy, chair of the Senate Health, Education, Labor and Pensions Committee, is urging Congress to steer the aid into patient‑controlled accounts rather than to insurers. The idea has drawn support from President Donald Trump and interest from some senators as leaders prepare a December vote secured in the deal that ended the shutdown.
Congress is turning from reopening the government to deciding the fate of enhanced Affordable Care Act (ACA) premium tax credits that expire at the end of this year. Sen. Bill Cassidy (R‑La.), who chairs the Senate Health, Education, Labor and Pensions Committee, is promoting a plan to send those dollars directly to individuals—preferably through Health Savings Accounts (HSAs)—rather than to health insurers. Cassidy has argued on the Senate floor that funnelling billions to insurers lowers premiums for some but does not make health care itself more affordable, and he says directing funds to patients would increase control and price transparency. He initially floated a pre‑funded flexible spending account model but now favors HSAs as more practical. (Cassidy floor remarks and releases; KFF background on expiring credits.)
Cassidy told the Daily Wire he is discussing the concept with both Republicans and Democrats and that “there’s things you have to work through” across the aisle. He also said he and President Trump were “in sync” after Trump publicly backed sending ACA subsidy dollars “directly to the people” in a Nov. 8 post. Axios and the Washington Post reported that Trump endorsed the direct‑to‑consumer approach as the shutdown fight intensified. (According to the Daily Wire; Axios; Washington Post.)
The political context has shifted since Congress ended a 40‑plus‑day shutdown with a bipartisan funding package. As part of that deal, Senate Majority Leader John Thune (R‑S.D.) committed to hold a separate vote by the second week of December on ACA subsidies or an alternative, while leaving the government‑funding bill free of health policy provisions. The Washington Post and the Guardian reported the promise, and subsequent Senate action advanced the funding plan; the House then sent a bill to Trump to end the shutdown. (Washington Post; the Guardian; Time.)
During the shutdown, Senate Minority Leader Chuck Schumer (D‑N.Y.) proposed a one‑year extension of the enhanced credits; Senate Republicans quickly labeled the offer “dead on arrival.” On Nov. 8, Senate Majority Whip John Barrasso (R‑Wyo.) criticized Obamacare on the floor, saying Americans “deserve quality, affordable health care” and arguing Schumer’s plan would make “insurance companies richer and taxpayers poorer.” (Washington Post; Barrasso office.)
House Democratic Leader Hakeem Jeffries (D‑N.Y.) has warned that “tens of millions” could face sharply higher premiums, copays and deductibles if the credits lapse, and he is pushing a three‑year extension. His office reiterated those points in multiple press appearances this fall. (Jeffries press releases; CNN interview summary.)
The Senate Finance Committee scheduled a hearing on health‑care costs for Wednesday, Nov. 19, with witnesses from the American Action Forum, the Urban Institute and the Paragon Health Institute; the session is expected to inform the coming debate over the credits and alternatives. (Senate Finance Committee docket.)
Nonpartisan analyses underscore the stakes: the Inflation Reduction Act extended the enhanced credits through 2025, and KFF estimates out‑of‑pocket premium payments for subsidized marketplace enrollees would, on average, more than double in 2026 if the enhancements expire. (KFF.)
Cassidy says the direct‑to‑individual approach can attract bipartisan support. According to the Daily Wire, he cited public backing from Sen. Bernie Moreno (R‑Ohio) and interest from Sen. Maria Cantwell (D‑Wash.). No bill text outlining Cassidy’s HSA‑based mechanism has been released as of publication, though House Republicans are circulating HSA‑focused proposals and separate HSA expansion measures are already on file. (Daily Wire; Politico; Congress.gov.)
