Topline
Senators are expected to vote Thursday on a GOP-backed plan to replace expiring Affordable Care Act tax credits with direct payments to health savings accounts for some enrollees—but the plan is unlikely to offset rising premiums, especially for those with the most health care needs.
Senate Majority Leader John Thune (R-SD) (C), joined by Senate Majority Whip John Barrasso (R-WY) (L) and U.S. Sen. James Lankford (R-OK), speaks to reporters following a Senate Republican policy luncheon at the U.S. Capitol on December 09, 2025 in Washington, DC. (Photo by Heather Diehl/Getty Images)
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Key Facts
Individuals enrolled in “bronze” or “catastrophic” plans earning less than 700% of the federal poverty level would receive $1,000 in their HSAs if they are 18 to 49 years old and $1,500 if they are 50 to 64.
The proposal from Sens. Bill Cassidy, R-La., and Mike Crapo, R-Idaho, aligns with President Donald Trump’s push to make direct payments to individuals rather than insurance companies—Trump said he supports the HSA idea generally on Tuesday, telling reporters, “I like the concept. I don’t want to give insurance companies any money. They’ve been ripping off the public for years.”
The plan essentially reverses the existing funding model: enrollees currently have subsidies paid directly to their insurers to cover premiums while being responsible for deductibles, while the proposal would grant HSA funding for deductible payments—though those could not be used to pay premiums.
Critics argue this is a net loss for enrollees, as most would receive less support under the HSA proposal than the existing ACA tax credits, since it would only apply to high-deductible plans (the average deductible for individuals with a bronze plan was $7,200 this year, according to the Kaiser Family Foundation nonprofit).
The proposal would also expand eligibility for the catastrophic plans to everyone, likely leading insurers to raise premiums for people with more health issues who are concentrated in the more comprehensive plans, the left-leaning Center for American Progress notes.
The plan also doesn’t apply to children and “there’s no adjustment of income, meaning this proposal wildly favors weather—and healthier—enrollees,” Sabrina Corlette, a Georgetown professor who specializes in health care policy, told NBC News.
What To Watch For
The Senate is expected to vote Thursday on both the Cassidy-Crapo proposal and a bill backed by Democrats that would extend ACA premium tax credits for three years. Both proposals are expected to fall short of the 60 votes needed to break the filibuster in the Senate, increasing the likelihood the credits will lapse and premiums will spike. Trump has consistently said he wants a health care plan that sends money directly to people—not insurance companies—suggesting Americans could refer to the new plan as “Trumpcare.”