GOP Senator Bill Cassidy Floats Prepaid HSAs over ACA Tax Credits

With ACA open enrollment well underway for 2026, the race is on for Americans who use the exchange to find something they can afford, yet still meets their healthcare needs. President Trump and most of the Republican Party are pushing against renewing the ACA subsidies. The preferred alternative involves using that money to create Roth HSAs instead. Senator Bill Cassidy has been especially outspoken about moving in this direction.
High-Level Overview of How the HSA’s are Presently Being Pitched
The Louisiana Republican’s proposal presently suggests extending pre-paid HSAs to Americans who select the high deductible Bronze plan in the Obamacare marketplace. Though the HSA wouldn’t pay the monthly premium, Cassidy, who is the chairman of the Senate Committee on Health, Education, Labor and Pensions, told CNBC that it would help to pay for healthcare related expenses such as co-payments, deductibles, and coinsurance.
A Bronze plan typically pays about 60 percent of the insured’s costs, with the remaining 40 percent needing to be covered out-of-pocket.
“Is there anybody who would not want to take a large portion of that, which we’re using to help Americans purchase health care, and give it directly to the individual, so that 100% of it is used to purchase health care, as opposed to giving that money to the insurance company, of which 20% goes for profit and overhead?” Cassidy asked.
Cassidy’s plan has captured the attention of President Trump as being in line with a direction he was already thinking of for healthcare. In fact, Trump told The Hill that he’d prefer to pass legislation that would allow Americans to have direct access to funds that enabled them to choose and purchase healthcare on their own.
“I like my plan the best. Don’t give any money to the insurance companies, give it to the people directly. Let them buy their own healthcare plan. And we’re looking at that. If that can work. We’re looking at that,” Trump said last week before Thanksgiving break.
Federal HSAs Not a New Idea
Cassidy’s idea isn’t exactly new. It was initially pitched back in 2018, and in a nutshell, it put the issue of healthcare on a level for states to decide how they wanted to handle it. Cassidy’s plan, entitled “Patient Freedom Act” proposed a general overview of three options to states:
1. States could choose to continue to use Obamacare and not make any changes to it.
2. States could adopt a “market-based health insurance system under which Roth HSAs will be created for residents enrolled in qualified health plans,” the plan notes.
The catch with this plan is that enrollees could only select the HSA option if they “are not eligible for coverage under Medicare, and not enrolled in Medicaid, CHIP, TRICARE, FEHB or programs providing veterans’ health benefits.” In addition, the Roth HSA tax credits would be phased out “beginning at $90,000 for single enrollees ($150,000 for married couples).”
As for how much each enrollee may contribute to their HSA, the most that can be contributed each year is about $5000, unless a person is age 55 or older, in which case an additional $1000 may be contributed annually.
3. States may opt to choose their own health insurance system without federal funding. Basically, they’d be creating their own state-funded solution to resolve (or at least minimize) the healthcare conundrum for their citizens.
Alternative Healthcare Options to Consider
While there may be some revisions to how healthcare is going to function as Congress and the President continue to discuss healthcare, it’s definitely important for Americans to pay attention and be in communication with their representatives regarding their preferences for the future of healthcare.
In the meantime, for those who chose not to participate in the exchange and don’t have the benefit of employer-paid healthcare, there are other options to consider. A few companies worth checking out that offer cost sharing alternatives include Christian Healthcare Ministries, Zion Healthshare, Medi-Share, and Redeem HealthShare. Two resources that may be helpful for comparing cost sharing and insurance alternatives are Ramsey Solutions and HSA for America.
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Originally published December 01, 2025.





