Over the weekend, Senator Bill Cassidy went on Fox News Sunday and did something very few elected officials are willing to do. He laid out his own plan to deal with the health care crunch that will hit millions of Americans next year if Congress lets key Affordable Care Act (ACA) expanded tax credits expire at the end of December.

You can watch his interview here.

About 24 million people are enrolled in ACA marketplace coverage this year, and roughly 22 million receive the enhanced premium tax credits that Congress initially passed into law during the COVID pandemic. Congress did not make the credit permanent; they were initially scheduled to expire at the end of 2023 before they were extended until the end of 2025. But if these enhanced credits expire on December 31, premiums for marketplace plans are projected to jump by more than 100 percent on average, and several million people could lose coverage in 2026 because they will not be able to afford it.

To understand what Sen. Cassidy is trying to do, it helps to step back and look clearly at how both Democrats and Republicans think about this debate.

From the Democratic point of view, three things stand out.

  • First, before the ACA, plans in individual insurance markets were often too expensive or completely unavailable for people with preexisting conditions.The ACA finally put rules in place so those people could get covered.
  • Second, while the exchanges are far from perfect, this is the system that exists today, and the enhanced tax credits have helped expand access to health insurance.
  • Third, allowing those credits to disappear overnight would mean very large premium increases for millions of families who followed the rules and bought coverage through the exchanges, and Democrats believe Congress should not pull the rug out from under them.

From the Republican point of view, there are a different set of realities.

  • First, the ACA originally passed on party-line votes, and most Republicans have never supported or voted to create or perpetuate it.
  • Second, the current fight is not about repealing the ACA. The initial exchange subsidies — which were previously available to people making up to 400% of the federal poverty line — will still be available in 2026 no matter what Congress does. The current debate is about whether to keep in place temporary, emergency-era enhancements that were passed during COVID and are now scheduled to end. There is a legitimate argument that a pandemic that is officially over should not be a permanent justification for higher federal subsidies.
  • Third, every Republican senator today identifies as pro-life, and many of them object to sending more taxpayer money through a system in which some subsidized plans cover abortion services.

These two sets of concerns have been colliding for years, and very few leaders have tried in a serious way to reconcile them.

Sen. Cassidy is one of the few who is trying. On Fox News Sunday, he explained that he is working on a framework that would help people facing higher costs in 2026 by putting money directly into their Health Savings Accounts (HSA) instead of simply extending the current subsidies. Under his outline, people buying coverage on the exchanges would have a choice to stay on their current policy or move to a lower-premium plan and receive new contributions into an HSA to help pay their out-of-pocket costs.

This is not the first time Sen. Cassidy has stepped into a politically dangerous issue. Earlier this year he and Senator Tim Kaine (D-VA) put forward a bipartisan plan to protect Social Security.

In a political climate where many elected officials stick to safe talking points and wait for someone else to take the risk, Sen. Cassidy is once more choosing a different path.

Right now, we want to hear your thoughts. Should congressional leaders take up Sen. Cassidy’s health care plan? Take our one-question survey now.