Republicans eye HSAs, ACA overhaul as enhanced subsidies near end

Modern Healthcare – Wednesday, November 19, 2025
By Michael McAuliff

Fifteen years after the Affordable Care Act of 2010 became law and less than two months before generous insurance subsidies expire, Republicans are rally around an old favorite: health savings accounts.

President Donald Trump’s exhortations that Congress should send money directly to households, rather than subsidize insurance premiums, loosely fits into the HSA framework, and GOP lawmakers are floating specific proposals. But other ideas are proliferating, including phasing out the ACA itself and reviving policies that didn’t make it into Trump’s tax law.

Many of the ideas do not work together or do not address the immediate problems millions of people face as health insurance exchange premiums skyrocket and federal assistance diminishes next year.

Yet the mere fact that Trump and his party are returning to HSAs and other conservative health policies is a reflection of their political bind. That’s partly the result of the reality that Republicans’ constituents are disproportionately affected by the expiration of the enhanced premium tax credits and partly the result of Democrats capitalizing on that fact.

The White House and congressional Republicans say they are developing a plan but details are scant.

Trump flatly declared Tuesday that he does not support extending the enhanced subsidies. “THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES,” he wrote on Truth Social, his social media platform.

Some Republicans on Capitol Hill have been quick to embrace the idea, including Senate Health, Education, Labor and Pensions Committee Chair Dr. Bill Cassidy (R-La.). The Senate Finance Committee, on which Cassidy sits, is holding a hearing on the subject Wednesday.

Repealing, or at least significantly curtailing, “Obamacare” remains a goal for many Republicans.

Rep. Morgan Griffiths (R-Va.), who chairs the House Energy and Commerce Committee’s health subcommittee, suggested Congress could phase out the exchanges and the subsidies over time, rather than allow huge rate hikes to hit consumers in January. Griffith also emphasized a popular GOP talking point that a small number of exchange enrollees who receive subsidies but don’t use their benefits is a major concern.

The GOP-led House simply won’t approve any extension of the enhanced subsidies without sweeping changes to the entire healthcare system that go beyond the ACA, said Rep. Dr. Andy Harris (R-Md.), who chairs the conservative Freedom Caucus. That includes tackling Medicare Advantage plans collecting more revenue by “upcoding” the severity of their members’ ailments, he said.

Senate Minority Leader Chuck Schumer (D-N.Y.) ripped Trump’s suggestions — and, by extension similar ideas, from other Republicans — as nonsense.

“He still has no idea how anything actually works,” Schumer said in a news release Tuesday. “His ‘plan’ makes no sense. Sending people a few thousand dollars while doing nothing to lower healthcare costs is a scheme to help the ultra-wealthy at the expense of working people with cancer or preexisting conditions.”

Healthcare business interests generally support renewing the subsidies and not executing major health policies in a hurry.

“Right now, there’s a cost-of-living crisis facing over 20 million Americans — they can’t afford their health coverage starting in January,” said Charlene MacDonald, executive vice president at the Federation of American Hospitals. “The only solution is to extend the tax credits. We can have a broader conversation about healthcare, but Congress has an immediate solution to the problem at hand, and they need to take it.”

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