[Congressional Record Volume 171, Number 208 (Wednesday, December 10, 2025)]
[Senate]
[Pages S8612-S8616]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                  Health Care Freedom for Patients Act

  Mr. CRAPO. Mr. President, tomorrow, this Chamber will have the 
opportunity to chart a new path forward on healthcare in this country.
  Senators will be given the choice to extend the Biden COVID bonuses 
for another 3 years or to support healthcare reforms that will actually 
expand options, reduce premiums, and give power to patients instead of 
insurance companies. Both sides agree that the cost of healthcare is 
too high, but we need to address the root causes of the explosive 
increase in healthcare costs rather than mask them with unsustainable 
spending.
  We are told that the expiration of the enhanced ObamaCare subsidies 
is a crisis and that there is no time left to do anything but extend 
them. If there is a crisis coming, it is entirely of the Democrats' 
making. My colleagues on the other side of the aisle created the 
premium tax credits as a part of the ObamaCare system because they did 
not trust their own policy to make healthcare insurance affordable 
without shifting the burden of paying for it from enrollees to 
taxpayers. When the original premium tax credits failed to bring down 
premiums, they enhanced the tax credits. Then, when that did not work, 
they extended the enhancements.
  They did all this without a single Republican vote. They also chose 
the current expiration date that they now say must be changed. They 
created the very cliff that they now oppose.
  Our colleagues on the other side of the aisle have had years to offer 
serious suggestions on how to reform the ObamaCare subsidies. Yet every 
time that deadline approaches, we are told there is no workable option 
except to extend them again. It seems that these subsidies were never 
truly meant to be temporary, but they should be.
  We do not have to go along with their last-minute extension this time 
at the cost of $83 billion. Even our Democratic colleagues recognize 
that our healthcare system needs reform. Leader Thune recently quoted 
many of them here on the Senate floor.
  They said:

       We did fail to bring down the cost of healthcare.

  They also said:

       Now, right now, we have a broken health care system.

  And it is not just the rising premiums that prove that ObamaCare is 
broken. We cannot ignore the pervasive fraud in this subsidy program. 
The rules governing eligibility for these

[[Page S8613]]

credits are often flaunted. In September, the Wall Street Journal 
reported that the rule barring people who can access affordable 
insurance through their employers is ``barely enforced.''
  Based on the Government Accountability Office's recent audit, income 
and citizenship verification rules are being ignored too. Of their 24 
fake applications for enhanced tax credits, 22 are receiving subsidies 
despite submitting falsified paperwork or no paperwork at all. One of 
their applicants even received an email specifically confirming his 
income verification was approved even though he never submitted any 
proof of income in the first place.
  The law prohibiting dual enrollment in ObamaCare and Medicaid was 
broken 1.6 million times last year.
  Of course, unscrupulous insurance brokers have been signing people up 
for ObamaCare plans without their knowledge of them or their consent 
for them. Alarmingly, insurers make the most money through these 
fraudulent credits because they retain the money even if no payments 
are made on behalf of the patients.
  As just one example, more people are signed up for zero-dollar 
premium ObamaCare plans in Miami-Dade County than there are low-income 
people living there. One woman in Miami said she had been paid five 
times by brokers to enroll in ObamaCare plans.
  These are not isolated incidents. This year, 6.4 million Americans 
were improperly enrolled in enhanced ObamaCare subsidies at a cost of 
$27 billion. The true cost of fraud was likely even higher because the 
GAO also found in its report that tens of billions of dollars of 
subsidies in 2023 had not been reconciled to the enrollees' incomes, 
meaning they could have misrepresented their incomes to qualify for 
bigger subsidies.
  This is the program our colleagues on the other side of the aisle are 
prepared to extend without changes, without even changing the policies 
that are generating fraudulent abuse.
  We can't afford to do that. We cannot afford the $83 billion pricetag 
of their proposal, and we cannot afford to tacitly consent to this 
fraud nor can we afford to tell the hundreds of millions of Americans 
who are insured through means other than ObamaCare that we are not 
interested in their rising premiums.
  While Republicans did not create this crisis--we did not create 
ObamaCare; we did not create these subsidies; and we did not create 
this expiration date--we do have plans to address it.
  Senator Cassidy and I introduced a sound plan earlier this week. Our 
bill, the Health Care Freedom for Patients Act, is based on an idea 
endorsed by President Trump and many of our colleagues whereby 
Americans, not insurance companies, should control their own healthcare 
spending. Americans could use the permanent, original premium tax 
credits to purchase qualified bronze plans with a health savings 
account attached. They would then receive monthly contributions into 
that health savings account totaling $1,000 to $1,500 per person in the 
family annually.
  Instead of lining the pockets of big insurance companies, like these 
subsidies, our HSA contributions would help patients pay expenses not 
covered by their insurance plans.
  When patients can control their own care, they can seek the most 
appropriate treatment options for their individual circumstances, 
incentivizing care providers to compete for patients by improving 
prices and care outcomes.
  Our plan would also provide funding for cost-sharing reduction 
payments, which will reduce out-of-pocket costs for low-income 
patients, save taxpayers money, and--get this--reduce premiums for 
benchmark Marketplace plans by 11 percent.
  Additionally, our bill would ensure Federal health funding is spent 
for the benefit of Americans by strengthening citizenship verification 
requirements and discouraging States from providing taxpayer-funded 
healthcare to those who are not legally here and are not citizens of 
the United States.
  Some of our Republican colleagues have offered plans of their own 
this week which are also worth considering as we move to the future. We 
welcome bipartisan cooperation on these proposals as with the pharmacy 
benefit manager reforms I recently introduced with Senator Wyden and 
many of our Senate Finance Committee colleagues.
  But we must not simply kick the can down the road yet again. Every 
time we spend tens of billions of dollars for unsupervised and poorly 
designed subsidies, as our colleagues are asking us to do once again, 
we worsen the healthcare crisis that we all want to solve, and we do 
nothing to stop the explosive increase in premiums.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. CASSIDY. Mr. President, tomorrow, we are going to vote on two 
different visions of how to cover the cost of health insurance on the 
ObamaCare exchanges.
  Democrats want to cover the cost of health insurance to benefit 
insurance companies. I will tell you why I am saying that--because I 
can make that case. Republicans want to cover the cost of health 
insurance for the actual person who is buying the insurance--the 
patient, if you will. That is the difference between the Democratic 
plan and the Republican Health Care Freedom for Patients Act. So let me 
just kind of build that out.
  How do we make healthcare affordable again?
  First, the Democrats want people to pay $6,000 out of pocket before 
the insurance kicks in. The Republicans want to put thousands of 
dollars in the patient's pocket so she has that to pay before she 
actually gets into her deductible.
  Let me demonstrate with this chart.
  The Democratic plan is to give 100 percent of the money to the 
insurance company of which the insurance company takes 20 percent for 
profit and overhead. Then it uses the rest of the 80 percent to pay for 
the insurance that they think--that they agree--the patient needs.
  Our plan puts the money in the patient's purse, her pocketbook, her 
wallet. One hundred percent of the money in there is used for the care 
she knows she needs. She doesn't have to get permission from the 
insurance company. She knows she needs it. She can see her doctor, her 
dentist. She can get her pharmaceuticals. She can get eyeglasses, 
dental care, and orthodontia. That is a patient-driven account.
  This is the plan that Senator Crapo--the Finance chairman--and I 
propose. So let's compare the two plans. Again, they are two competing 
visions, two different ways, and I would argue that the Democratic plan 
principally benefits insurance companies and that the Republican plan 
is there to benefit the patient.
  Let's look at this.
  The Democrats just want to extend the enhanced premium tax credits. 
Who gets the money? Insurance companies. Under our program, where the 
money goes to the patients, the patients and their families get it.
  What can it be used for?
  Of the enhanced premium tax credit that the Democrats wish to extend, 
there are no changes whatsoever--3 years of subsidized premiums. That 
goes to the insurance company. On our side, the money that the patient 
gets in that account--the money that we put into her pocket so she can 
pay the out-of-pocket for the insurance company--goes for real care: 
the dentist, the physician, the glasses, the prescriptions.
  Who makes the decisions? Under the Democratic plan, the insurance 
companies make the decision. Under our plan, the patient makes the 
decision. We give power to the patient, not profit to the insurance 
company.
  Does it lower costs? Clearly not. What we have seen since ObamaCare 
was passed is costs explode. We continue to have the healthcare 
inflation we are looking at now.
  But if we empower the patient and if we give her the money and we say 
``The more careful you are spending this money, the more that money is 
going to stretch,'' I can promise you, she is going to be like every 
other responsible wife, mother, keeper of the family wallet: She is 
going shop.
  Wait, my x ray is $50 here. No, my x ray is $500 there. I am going 
where it is $50.
  She will make the wise financial decision for her family.
  How does it work with low-cost bronze plans? Here, under the 
Democratic plan, we have just heard Senator Crapo point out how much 
fraud there has been with this system that we are currently under.

[[Page S8614]]

  Under the patient-driven account, the money goes into a health 
savings account--into your wallet, if you will--which is connected with 
your bronze, and the mechanisms by which we set that up make sure we 
cut out that fraud.
  Our bill goes after that fraud; their bill tolerates it. There is 
nothing in their legislation to stop the fraudulent stealing of 
billions of dollars of taxpayers' money. What it does do is it 
continues payments to insurance companies that take 20 percent of that 
money for overhead and profit, whereas under our plan, the money we 
give to the patient--100 percent goes to the care she knows she needs.
  That is the plan Republicans are proposing. To put it differently, 
under the Republican plan, there is power to the patient. Under the 
Democratic plan, there is profit and power to the insurance company. 
Under the Republican plan, the patient uses the healthcare money in her 
wallet to purchase the care she knows she needs. Under the Democratic 
plan, you go to the insurance company and plead: Please, baby, please 
can I get permission to get the care I know I need?
  The Republican plan meets the American people where they are 
financially. Studies show that only like a--that most families have 
less than $1,000 worth of savings. Under our plan, we recognize that, 
and we put money in their wallet, pocketbook, or purse so that they can 
pay for the care they need before they go into their deductible.
  Like this. This is a new poster for people who have heard my talk 
before. This is the Democratic plan. You get a $6,000 deductible, and 
that is what you feel like, that woman right there when she is stressed 
because she doesn't have the money to pay for the care her family 
needs.
  Here in her health savings account, the money is, if you will, in her 
purse, and when the doctor says ``You need this prescription for you 
son's earache,'' she has the money to pay for it right off the bat.
  The Democratic plan brings financial stress--profits to the insurance 
company; stress to the patient. The Republican plan--money in the 
pocket to pay for the out-of-pocket for the insurance plan.
  Now, by the way, this plan in which we put money in the pocket of the 
patient to pay for the out-of-pocket of her insurance policy the 
Democratic leader has called a junk plan.
  Now, pause for a second. Democrats put that plan into place. 
Democrats actually put these plans on the ObamaCare exchange. He is 
calling a junk plan that which they have been preserving for the last 
10 years, swearing up and down that it meets the needs of the American 
people.
  All Republicans have done is added to it something called a health 
savings account, if you will, money in the patient's purse, pocketbook, 
or wallet to pay for the out-of-pocket associated with this plan.
  To call this a junk plan just shows that the Democratic leader does 
not know what we are talking about or that hypocritically he has been 
defending an ObamaCare law which created this very plan.
  By the way, I was smiling last night when I saw that the New York 
Times mimicked this talking point like a Democratic Party organ.
  What is junk? That for a family of four--two parents in their 
fifties, children 18 and 19--that they get $5,000 a year? Think about 
that--$5,000 a year for that family I just described to pay for their 
initial healthcare expenses.
  Think about if one of those children had diabetes--chronic care. 
Under our plan, they have $5,000 to help pay for that chronic care 
right off the bat. Under the Democratic plan, with a $6,000 deductible, 
you are paying for that out of pocket, and that is what your face looks 
like because you cannot afford it. Our plan relieves the stress.
  Now, next, the minority leader says that he wants to reject all these 
benefits. He wants to continue to send 100 percent of the money to the 
insurance company, which takes 20 percent for profit and overhead, 
as opposed to sending the money to the patient for her purse, wallet, 
or pocketbook so that she has money in the pocketbook to pay the out-
of-pocket from the insurance company.

  He is defending that with a $6,000 deductible because he says that 
Republicans want to prevent taxpayer-funded abortions. He wants to have 
taxpayer-funded abortions apparently, and Republicans, consistent with 
the American will, as we have for decades, think that we should not do 
that.
  Somehow, he is making out like this is a new development. Well, just 
for the sake of the American people, the so-called Hyde amendment, 
which prevents Federal dollars from being spent on abortion, has been 
agreed to by Democrats on annual appropriations bills since the 1970s. 
They have been agreeing to this for 50 years, and all of a sudden, that 
is being used as a rationale to send 100 percent of the money to the 
insurance companies, which take 20 percent of it for profit and 
overhead, as opposed to sending thousands of dollars to the patient for 
her to pay first-dollar coverage, to have it in her pocketbook to pay 
the out-of-pocket for her insurance plan.
  I don't want this to seem partisan. I have been saying ``Republican'' 
and ``Democrat,'' but let me say that we should not have a Republican 
plan; we should not have a Democratic plan; we should have an American 
plan.
  This is a cartoon representing an American, but think of the person 
you know. Think of the person you graduated from high school with--good 
people. Good people. Several kids. Trying to make ends meet. They don't 
have a lot of money. But good people. That is who I am talking about.
  Let's just separate this from R versus D. What about the people we 
are supposed to care about who cannot afford a $6,000 deductible but 
would love to have thousands of dollars in their purse, pocketbook, or 
wallet to pay for the out-of-pocket costs associated with that 
insurance plan? Isn't that where we want to be?
  Now, just to put a face on this--maybe some numbers, I should say. 
This is real. This is off healthcare.gov from 2026, this coming year. A 
family of four, a couple in their fifties with two children, 20 and 21; 
500 percent of the Federal poverty level--about $160,000, I think, per 
year, OK? Under our plan, they would be able to get a bronze plan as 
opposed to a silver, which saves them roughly $6,000 per year. The 
amount in their health savings account--if you will, in their 
pocketbook, purse, or wallet, in their pocketbook to pay the out-of-
pocket costs of the insurance plan--would be $5,000.
  Under what Democrats are insisting they must buy--will not give them 
an option--they have zero dollars to pay toward that $6,000 deductible. 
And the net deductible--because they say: Oh, my gosh, if you get a 
plan with a lower premium, your deductible is higher. Because of the 
money that would be going into the health savings account, the net 
deductible is cheaper with a cheaper policy under the Republican plan. 
Under the Democratic plan, the net deductible is higher.
  Let me add one more thing. Senator Crapo spoke about the incredible 
amount of fraud associated with the current implementation of 
ObamaCare, and the Democratic leader wants a straight-up, clean 
reauthorization for 3 years. He does not want to fight that fraud.
  Whatever bill was put up in the past, that is not what he is talking 
about now. He is talking about right now not only 100 percent of the 
money going to the insurance company with $6,000 deductibles; he is 
talking about continuing a system that is rife with fraud.
  If you are at home--no. If you are at work and you are working so 
hard and you are paying taxes to support our country and you hear there 
is fraud, it should drive you crazy. It drives me crazy.
  Why won't our Democratic colleagues join us in doing things to stop 
that fraud? I have never seen a party so committed to generating 
profits for insurance companies as what I am seeing right now.
  Let's cut that fraud. Let's put the money in the purse, pocketbook, 
or wallet of the American citizen to give her money to pay for the out-
of-pocket costs of the insurance company. Don't stick them with a 
$6,000 deductible. Let's give power to the patient, not profit to the 
insurance company.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California.

[[Page S8615]]

  

  Mr. PADILLA. Mr. President, we are here today just about a month 
after the longest shutdown in American history. You all remember the 43 
days that we went without a fully functioning Federal Government.
  Let's remember why that happened. Plain and simple, it was because 
our Republican colleagues refused to take steps to save healthcare for 
millions of Americans. In large part--I don't know if it was an 
individual choice or simply because there was no direction from the 
White House to come in and do so. All I know is that our Republican 
colleagues in Congress refused to come to the table, refused to 
negotiate with Democrats, refused to acknowledge that we were literally 
weeks away from a crisis that will kick millions of people--millions of 
Americans--off their health insurance unless Congress acts.
  That is the point Democrats are trying to make, and that is the issue 
we were trying to address during the shutdown because the 
appropriations process is the opportunity to address a crisis that is 
right around the corner.
  Now, eventually, yes, a handful of my Democratic colleagues took the 
Republican majority at their word that after voting to reopen 
government, addressing this spike in healthcare costs was the next 
order of business.
  At the time, I expressed my skepticism to go along with a promise to 
fix something later from a party that earlier this year enacted the 
biggest cuts in history to Medicaid. I find it hard to take the word of 
the Republican majority that they are committed to addressing 
healthcare costs and to expanding coverage to more Americans when they 
just kicked 15 million Americans off their insurance.
  So, yes, just about a month after this longest shutdown in American 
history, we now find ourselves 3 weeks away from the expiration of the 
Affordable Care Act tax credits that so many of us are talking about.
  Now, have hope because Democrats are here with a plan. We will ask 
this body to vote on a straightforward, 3-year extension of these 
lifesaving subsidies that we all support. The question will be, Are 
there enough Republicans that will join us in doing so? Keep people on 
their healthcare, and we can do the policy work and negotiation to 
address some of the genuine concerns that we have heard about over 
these last couple of months.
  But don't let health coverage lapse for millions of Americans. This 
isn't a game. We are 3 weeks away from the catastrophic spike of costs 
in health insurance for so many. Over 20 million Americans are on the 
verge of seeing their monthly premiums not just increase but skyrocket. 
Four million Americans could be forced to give up their insurance 
altogether, including 400,000 in California, my home State.
  The increase in premiums mean hundreds, if not thousands, of dollars 
more monthly--not annually but monthly--for working families, working 
families who are already having a tough time making ends meet as costs 
are rising all around them: cost of groceries, cost of energy bills, 
cost of housing, and now cost of healthcare too?
  It is to the point that Americans are having to make these tough--
tough--choices: Do I pay the rent? Do I pay the water bill? Do I pay 
the light bill? Can I even afford health insurance next year for my 
family? That is a truly heartbreaking decision that is happening all 
across the country.
  I know you are hearing from your constituents, and I am hearing from 
mine. I hear from people like Lisa, a single mom from Meadow Valley, 
CA, who was diagnosed with Hodgkin's disease in 1996. Thank God today 
Lisa is cancer-free, in no small part thanks to her regular checkups 
and the affordable healthcare plan that she can participate in because 
of these tax credits.
  But in 2026, Lisa isn't just looking after herself and her own 
health, she is looking after her son. She is a single parent. She is 
looking after her parents as they are aging. They are now in their 
eighties, and she is wondering whether this lapse in tax credits might 
put her necessary treatments out of reach. So I am here not just 
speaking up, I am here fighting for her.
  I hear from people like Lana, a small business owner in Oakland, CA, 
who has two kids in college--and college isn't cheap--and she says:

       It is tough to be in the middle class right now.

  Lana is so determined to give her kids a good education, but with 
less financial aid available--right, don't get me started on what else 
has been cut by this Republican majority in Congress--for her, it 
fundamentally means redirecting money that would otherwise go to her 
retirement plan.
  So imagine that, having to choose between investing in your future 
retirement or your kids' education or your access to healthcare. While 
the subsidies for the ACA premiums still exist, she is able to make it 
work. Without those subsidies, she doesn't know what is going to have 
to go. Do you give up your healthcare? Do you have to start dipping 
into your retirement, putting your future financial security at risk, 
or do you give up your kid's dreams of higher education?
  Again, that painful choice is the reality for so many families right 
now, and so I am fighting for them too. But I can go on and on with 
story after story, example after example. It doesn't have to be this 
way. That is why Democrats have put forward this serious, tangible plan 
to avoid this fiscal crisis, this healthcare cost crisis for families 
across the country.
  And the fact of the matter is, our Republican colleagues don't have a 
serious plan. Look no further than to the fact that it is the eleventh 
hour now, and they have put forward a proposal that wouldn't lower 
premiums for a single American. In fact, it would make the problem 
worse. It would allow the tax credits to expire. It would increase 
premiums and deductibles for tens of millions of Americans. It will 
push many people into what may be referred to as the ``bronze plan'' 
or, in reality, a catastrophic plan, the least comprehensive coverage 
on the market with sky-high deductibles.
  And some of these plans you get a thousand-dollar coupon. That 
doesn't do a hell of a lot when these drug plans are forcing families 
to pay thousands of dollars out of pocket before the insurance even 
kicks in, and it certainly won't protect people from financial ruin 
when they get truly, truly sick.
  But, sadly, it is not surprising. It is not shocking. This is an 
eleventh-hour proposal idea coming from a party that for 15 years has 
been talking about repeal and replace--not just attacking the ACA. They 
vow to repeal and replace. Repeal and replace. No shortage of efforts 
to repeal the ACA, but in 15 years, they haven't come up with a plan to 
replace it, certainly not a better plan to replace the ACA.
  So let's get real. We know that this will cause hardship, and the 
hardship and the pain that is so tragic is made worse because we know 
it is preventable.
  So let's vote tomorrow and pass this clean 3-year extension of the 
ACA tax credits if we are to improve upon the policy and the plans that 
are in place.
  It is not controversial, folks. The overwhelming majority of American 
people support extending the ACA tax credits and not just supportive of 
what we are doing, Americans are demanding that we do something about 
the cost of healthcare and the cost of living overall.
  You have seen Trump's approval ratings on the economy, haven't you? I 
know you are well aware of the election results from last month when an 
overwhelming majority of Americans cast their ballots rejecting Trump 
and Republican policies that are putting billionaires over the needs of 
working families. They are fed up. They are demanding that their 
government do something to help them get by; to help them survive, in 
many cases; to address the affordability crunch, a true crisis that 
Donald Trump dismisses as a ``con job'' and as a ``hoax.''
  So here we are on the eve of a truly consequential vote to prevent 
costs from rising for the American people, to prevent healthcare from 
becoming out of reach for too many families. Here is our chance as a 
body to truly do something about that.
  So I urge everybody to vote yes, and let's help millions of Americans 
keep their healthcare come the new year because we know that a ``no'' 
vote will only rip that care away from millions of families.
  The choice, the conscience, couldn't be any more clear.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.

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