December 9, 2025, 3:08 PM ET
Senate Republicans are advocating for direct financial support to Americans instead of continuing the Affordable Care Act’s enhanced subsidies, which have made health insurance more affordable for many.
On December 8, Republican Senators Mike Crapo and Bill Cassidy unveiled a proposal aimed at depositing between $1,000 and $1,500 into the health savings accounts of qualifying consumers. This initiative would replace an extension of the COVID-19 era tax credits that have significantly lowered premiums under the ACA, often called “Obamacare.”
Senate Majority Leader John Thune confirmed that the Senate is set to vote on the Crapo-Cassidy proposal this Thursday, alongside a Democratic plan to prolong the ACA’s enhanced premium credits for another three years.
Cassidy, who chairs the Senate Health, Education, Labor and Pensions Committee, indicated that giving cash directly to patients could empower them to negotiate better prices and become more informed consumers of healthcare.
However, experts in health policy argue that many low-income individuals might still end up responsible for paying premiums under the proposed Crapo-Cassidy plan.
This proposal aligns with a concept previously suggested by President Donald Trump, emphasizing consumer-directed funds instead of supporting insurance companies, and represents just one among several recent Republican health proposals.
According to health policy group KFF, without the enhanced tax credits set to expire at the end of 2025, the average premium for the 22 million Americans receiving subsidized ACA coverage would more than double starting January 1, 2026.
What are the Republican alternatives for enhancing ACA subsidies?
The Crapo-Cassidy legislation stipulates that individuals aged 18 to 49 would receive $1,000 in their health savings accounts, while those aged 50 to 64 would get $1,500. These funds are aimed at people enrolled in bronze or catastrophic ACA plans who earn up to seven times the federal poverty level.
Health savings accounts complement high-deductible health plans, allowing consumers to save pre-tax dollars for eligible medical expenses, like visits to doctors, hospital bills, and medications. Importantly, these balances can roll over from year to year, and the funds can be invested, with profits being tax-free on qualified expenditures.
Cynthia Cox, KFF’s vice president and ACA program director, noted that while the Crapo-Cassidy plan could somewhat mitigate the financial blow from losing the enhanced premium tax credit, it would likely be beneficial only for a limited group of people—not the majority.
For instance, Cox pointed out that those who find it tough to pay monthly premiums for bronze or catastrophic health plans may not benefit from the health savings account payments.
Additionally, other Republican lawmakers are exploring their own alternatives. Senator Roger Marshall from Kansas has introduced a proposal to extend the ACA’s enhanced subsidies into 2026, followed by shifting funds to “healthcare affordability accounts” similar to HSAs in 2027.
Meanwhile, Senators Bernie Moreno of Ohio and Susan Collins of Maine are advocating for an extension of the enhanced ACA subsidies for two years, introducing new income limits and seeking to eliminate the zero-premium plans.
