[Congressional Record Volume 171, Number 187 (Friday, November 7, 2025)]
[Senate]
[Pages S8005-S8008]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HEALTHCARE

  Mr. CASSIDY. Madam President, I am going to try and envision a way 
forward for Democrats, Republicans, and Americans out of our current 
situation, with a different proposal than people have already thought 
of.
  Now, the government has been shut down for 38 days, and tomorrow we 
are going to vote again, and tomorrow the vote will again fail. But 
Americans and Congress are frustrated.
  We need to open the government. So if to open the government we need 
to talk about healthcare, let's talk about healthcare. Let's have a 
conversation in the family.
  We have an affordability crisis, and health insurance is part of it. 
Now, this is personal to me. I am a doctor. I practiced in a hospital 
for the uninsured and the poorly insured for 20 years, and many of 
those people that came to see me were middle-income Americans who could 
not afford their medical bills and could not afford insurance. I want 
to see this solved.
  But if we are going to solve it now, in this present circumstance, we 
need to move beyond entrenched ways of thinking that have settled us in 
our camps and refused to allow us to listen to the other person.
  And I thank some of my Democratic colleagues for being here. We have 
got to be creative.
  Now, the Affordable Care Act, ObamaCare--whatever you want to call 
it--tried to make healthcare affordable by giving insurance companies 
more money. The enhanced premium tax credit, EPTC, is the latest 
example. Next year, it would send $26 billion to insurers hoping 
families would see smaller bills.
  But that doesn't actually make healthcare less expensive, and for 
some, it actually makes the health insurance more expensive if you are 
not getting subsidized care on the exchange.
  So we can do better than just papering over the costs for subsidies. 
Instead of paying insurance companies to manage your money, let's trust 
Americans with a prefunded flexible savings account worth as much as 
the enhanced premium tax credit that they would receive.

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  Let me repeat that: a prefunded--not out of their salary but 
prefunded for the Federal taxpayer--equivalent in value to the enhanced 
premium tax credit that they would receive.
  Now, let me make it clear. I am not speaking for the Republican 
caucus. I am not speaking for President Trump. I am not even speaking 
as the HELP Committee chairman. I am speaking as a Senator and as an 
American that sees us at an impasse and is trying to think differently 
about how we can move forward.
  So I am going to present to my fellow Americans an idea that, 
hopefully, will move us out of this stalemate and go forward. And I 
want to try and speak as if I am speaking to the Americans back home.
  Here is the problem. Under the enhanced premium tax credit, if your 
insurance premium goes up, if the insurance company decides to pay 
more, they just get more subsidy from the taxpayer.
  Now, insurance companies get paid no matter what, and it doesn't 
matter how expensive the tab is. There is absolutely no incentive to 
bring the cost down. There is no transparency as to what the care 
really costs, and there is absolutely no reward for the family that 
goes to a place which is less expensive.
  It is like putting a bandaid on a broken bone. You are hiding the 
fracture, but you are not fixing the broken bone. Let's fix the broken 
bone, which is high healthcare costs.
  So put simply, the enhanced premium tax credit does not empower 
patients. It enriches insurance companies. By the way, they are 
important. We need them. But if I have a choice of empowering you, the 
American, or enriching an insurance company, I and we should pick our 
fellow American.
  Now, imagine a different type of help, not paying the insurance 
company another subsidy but putting money, prefunded, not out of your 
salary, but roughly equal to the enhanced premium tax credit--put that 
into an account that you control. Every eligible American citizen on 
the exchange would receive this federally prefunded flexible spending 
account, and it would work like the prepaid health account you use for 
real world health expenses.
  It would actually have more flexibility than your current insurance 
proposal. You go to the dentist; it can pay for dental care. You go to 
the orthodontist; it can pay for your orthodontal care. It can pay for 
eyeglasses, which typically insurance does not pay for. Prescriptions, 
drugs, medical supplies, your deductible, your copays--it can pay for 
it all.
  Now, it wouldn't pay for insurance premiums. This is about you 
spending directly for your healthcare costs, not about enriching 
insurance companies.
  It would pay for the care that families actually use. That is what a 
prefunded flexible spending account actually does.
  I keep emphasizing ``pre'' because I mentioned this to people, and 
they say: Wait a second. This has to come out of my salary.
  No, this would be the money that would go to an enhanced premium tax 
credit, and instead, it goes into this account that you control.
  Now, it seems complicated for some. I go and I mention it to them, 
and they say: Oh, boy, this is something different, Bill. This is a 
great idea, but it is kind of like, it is just too different.
  Seventy-two percent of Americans getting their healthcare through 
some government entity are offered flexible savings accounts. Forty-
seven percent of people getting insurance through their employer are 
offered FSAs. This is something that is used by millions of Americans 
already.
  So what I am proposing is just to give this option to people on the 
exchanges. And, by the way, the Federal Government already offers 
flexible savings accounts to people on the small business exchanges.
  Members of Congress, we are on the ObamaCare small business exchange. 
We have the option of choosing an FSA. My family has one. And the 
Department of Treasury already has an office through which they funnel 
money to pay for these flexible spending accounts that I, as an 
individual, choose to get.
  So what we are speaking of is just offering to people on the 
exchanges--on the individual exchange--that which is already offered to 
people on the small business exchange and paying for it by the same 
mechanism in which it is already done through that exchange.
  Now, still, there is going to be some bureaucracy involved, but if 
there is any President that can overcome the inertia of the bureaucracy 
to make it happen by January 1, 2026, it is Donald J. Trump. Donald 
Trump is the man who, when it was told to him it would take 18 years, 
10 years, 18 months to come up with a vaccine and a program to prevent 
COVID transmission, he did it in 10 to 11 months. This President can 
overcome the inertia, and we have a running start because the Federal 
Government is already doing this.
  Now, let me make clear the key differences between enhanced premium 
tax credits and federally funded flexible spending accounts.
  First, who gets the money? Under the enhanced premium tax credit, 
insurance companies; under this, it is patients and families.
  What can it be used for? Here, the premium tax credit goes for 
insurance premiums--period, stop, full stop. The money goes to the 
insurance company. Here, real care, your doctor visit, your deductible, 
your copay, your dentist, your glasses, your prescriptions, that sort 
of thing.
  Who makes the decision? The insurance company. Just wait and fight 
with them about a preauthorization. Under the flexible spending 
account, you make the decision. You have the power.
  And, lastly, does it lower costs? No. It is pretty clear. If we 
continue to fund insurance companies no matter what they pay, it drives 
up the costs. In contrast, if you empower the patient, that mother is 
going to find the most affordable option. It has been studied.
  If you give people something that they perceive as their own money, 
they hunt for that bargain. By the way, if they go and they find out 
that the cash price is cheaper than what the insurance company would 
charge them, they will have the option of using this for the cash 
price.
  So we have reforms in here that give the patient even more power. The 
good thing about that, as the patient saves money, so does the 
taxpayer, and that is a good thing.
  So the prefunded--prefunded, prefunded--flexible spending account 
doesn't treat people like dependents of the government, as do the 
enhanced premium tax credits. It treats you like a capable consumer who 
knows what is best for your family.
  You decide where to go for dental work. You decide your pharmacy. You 
decide whether to pay the cash price or the negotiated price that the 
insurance company offers you, and instead of Washington paying 
insurance companies to manage your day-to-day care, you manage it with 
fairness, transparency, and flexibility.
  Now, some will ask: Won't this cost money? Of course. In the first 
year, it will be about the same amount as the enhanced premium tax 
credit, and my Democratic colleagues should like that. But the 
individual would be getting better value through the federally 
prefunded FSA because she is spending it on that which she actually 
needs, as opposed to up to 20 percent of it going for overhead profit 
and administrative costs.
  It isn't just fiscally responsible. It is common sense. Who wouldn't 
rather have their money in their own pocket than for the insurance 
company to dictate how they spend it?
  So here is the choice before us: In conclusion, we can keep paying 
insurance companies to pay for over the higher costs, behind confusing 
bills, in a system which actually raises the cost for some, or we can 
give Americans the tools--we can trust our fellow Americans to pay for 
their care directly, at fair prices, with transparency.
  If you will, it puts patients first, not insurers. It encourages 
competition. It rewards smart choices, and it begins to make healthcare 
truly affordable, not by inflating subsidies but by unleashing the 
power of the consumer.
  Let's stop writing blank checks to insurance companies. Let's invest 
in our fellow Americans.
  I say this: We have to first open the government. This takes writing 
some legislation. We have to open the government.
  But we have to be willing to take a risk to solve a problem and not 
be

[[Page S8007]]

afraid to do something different. I have seen in our Chamber right now 
a hunkering down. We have not been able to solve it. So we are not 
going to try anything different. We are just going to wear the other 
side down until they wave the white flag.
  Now is the time to be creative. I am a rock-ribbed Republican, but I 
will just say what I just offered is not a Republican solution; it is 
not a Democratic solution. It is an American solution.
  Let's open the government. Let's work together. Let's fix healthcare 
and give the American more power than the insurance company.
  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Do I have consent to ask my colleague a question?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CANTWELL. Will my colleague yield for a question?
  Mr. CASSIDY. Absolutely.
  Ms. CANTWELL. Thank you.
  I noticed in your proposal that you are talking about something that 
you had hoped to effect January of next year. Is that correct?
  Mr. CASSIDY. That is the goal, to have this ready for next year.
  Ms. CANTWELL. What is the Senator from Louisiana's interpretation of 
how the market controls the--you are trying to create a market 
mechanism where you are giving the consumer the same amount of money 
you would give them in the tax credits to make the insurance more 
affordable, only through a health savings account. But how do you know, 
once you have that in a health savings account, the market is going to 
not still have an increase above that amount? So how do you think this 
affects the market?
  Mr. CASSIDY. One other question first, this is a flexible savings 
account, not a health savings account. There is a legal distinction, 
and I want to make that.
  When the enhanced premium tax credits are not renewed--we know the 
insurance companies have already set up their rates--and so the 
consumer, our fellow American, will be choosing from the offerings that 
have been made by the insurance company for them to choose from.
  The difference would be--and they will see, by the way, that the 
policy for someone at 400 percent of Federal poverty levels costs about 
$2,500 more a year than it otherwise would have with the enhanced 
premium tax credit.
  This would be supplemental. We would say to that individual: You are 
at 400 percent of Federal poverty level. Your policy is $2,500 more a 
year. You will get a flexible spending account prefunded to offset the 
cost of this.
  Now, if it is my family, I would say: Hmm, I have got $2,500. Maybe, 
instead of going for a silver plan, I will go for a bronze plan, 
because now I can offset the higher deductible with my flexible savings 
account. And because I am going for a bronze plan, my premium will be 
lower.
  But that is trust in the American people. We are plugging into the 
current insurance market. We are actually not changing at all how it 
functions.
  Ms. CANTWELL. Well, if the Senator would yield for another question. 
I am assuming that you think affordability is the key. I certainly 
think affordability is the key. Nobody wants to subsidize expensive 
health insurance. We want to create market mechanisms to drive down the 
costs of health insurance, not just spend money to buy expensive 
insurance, whether you buy it through the tax credit or buy it through 
a health savings account. We want to create those mechanisms.
  So, again, all of this is going to take place in November and 
December--right now, in December. So somehow you would make some 
calculation in January about what would go into a savings account or 
are you thinking of a flat number?
  Mr. CASSIDY. That is a wonderful question. No.
  The Federal Government knows--or put it this way. Many States have 
calculated what the insurance rate would be with an enhanced premium 
tax credit and what will the insurance rate be without the enhanced 
premium tax credit. It has been calculated for our fellow Americans 
what the value of enhanced premium tax credits would be if they signed 
up for a certain policy in their State, given their age and their 
health condition. They know that. The question is whether they get the 
credit or not.
  Well, they are not going to get it, so their policy is going to be 
higher. And this, under the plan--if we could agree to it--they would 
then get the FSA in an amount equivalent to that which they did not 
receive as a payment to the insurance company. Instead, it would be a 
payment to the flexible savings account they would have and that they 
would then use it for these services.
  Ms. CANTWELL. If the Senator would continue to yield.
  The issue is that, you know, so much of this is already set up, and I 
think you are trying to be creative in a way to--instead of the 
Alexander-Murray cost revenue sharing, I think you are trying to figure 
out something that would get people the same amount of money to make 
them whole over the next year or two; is that correct?
  Mr. CASSIDY. That is correct.
  Ms. CANTWELL. So I would say what we are trying to do is make people, 
as the market is out there, whole over the next year or two. That is 
exactly what we are trying to do.
  We are happy to debate how we make health insurance more affordable 
after that. That has been a goal of our side of the aisle for decades. 
We want to make it more affordable. Now, we will always be measured 
about how successful we have been on that, but I think that we are 
going to continue to strive to make it more affordable and really are 
proud that we drove down the uninsured rate with the Affordable Care 
Act because we covered more people, thereby lowering costs because of 
not having so much uncompensated care.
  So I am glad to see somebody saying ``let's talk,'' and let's put a 
proposal out there. Happy to continue to have a dialogue about any idea 
that helps us move forward.
  You know, the issue is that so many Americans are, in this moment, 
right now, making these decisions, and how you effect that for the next 
2 years is the biggest question.
  And you and I know if we said: OK. We are huddling tomorrow or, you 
know, the Finance Committee is huddling tomorrow, then everybody up 
here would be trying to convince us not to do various things. So the 
question is, How can we protect the Marketplace in the next year or two 
in the simplest way and then get about us going back to business, 
talking to each other, trying to work out what are the best creative 
ideas for lowering health insurance costs?
  I don't know why we haven't done a PBM bill. My colleague Senator 
Grassley and I have a bill. I think you have a proposal. Other people 
have proposals. We are letting PBMs get away with so much in the 
expensive prescription drugs. I don't know why we don't spend all our 
time driving down the cost of health insurance.
  I am happy to work creatively on ways to protect the market over the 
next 2 years so that we can finally get to some creative discussions. I 
thank the Senator.
  Mr. CASSIDY. Thank you for the questions, and let me just respond 
very quickly.
  I think the beauty of what I am proposing is it fits in very nicely 
with the insurance markets as they currently are. It doesn't require 
anything to change between now and January 1. It is too late to change 
those plans and those rates. It is just too late.
  This does not require those rates to change. This would be something 
which could benefit our fellow Americans next year and could be 
implemented by then.
  Yes, the bureaucracy is going to have to work hard. President Trump 
can get them to work hard.
  You mentioned several other reforms. I am in total agreement. We 
should be working together--Democrats and Republicans, that is what we 
need do to get something done--in order to come together for a set of 
proposals that will lower healthcare costs.
  And both as a member of the Committee on Finance as well as the 
chairman of the HELP Committee, it is my intent do that. We have got to 
do that.
  But this can work this year for Americans who are going to be on the 
exchanges, and that is my hope.
  I yield the floor.

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