Topline
The Senate on Thursday rejected a GOP-backed plan to replace expiring Affordable Care Act tax credits with direct payments to health savings accounts for some enrollees amid criticism from Democrats and some experts the proposal would be unlikely to offset the rising premiums.
Key Facts
The Senate voted 51-48 against the measure, with all Democrats and one Republican, Sen. Rand Paul, R-Ky., rejecting the proposal.
The proposal from Sens. Bill Cassidy, R-La., and Mike Crapo, R-Idaho, would have given individuals enrolled in “bronze” or “catastrophic” plans earning less than 700% of the federal poverty level $1,000 in their HSAs if they are 18 to 49 years old and $1,500 if they are 50 to 64.
The proposal aligned 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 would have essentially reversed 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 have granted 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 have also expanded 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 didn’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 also expected to vote Thursday on a bill backed by Democrats that would extend ACA premium tax credits for three years. It’s likely 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.”
