The Republican proposal from Sens. Bill Cassidy and Mike Crapo would have redirected some federal support from Affordable Care Act (ACA) premium tax credits toward health savings account (HSA) deposits for a narrower group of Marketplace enrollees. It proposed annual contributions of $1,000 or $1,500, depending on age, for eligible people in bronze or catastrophic plans. It did not extend the enhanced ACA premium tax credits, which expired at the end of 2025.
How the proposal would redirect support
The Health Care Freedom for Patients Act, announced by Cassidy and Crapo on December 8, 2025, proposed an HSA contribution program for eligible people enrolled in bronze-level or catastrophic qualified health plans through an ACA Exchange. Under the introduced bill text, federal money would go into an eligible enrollee’s account rather than being used as an advance premium tax credit to reduce that enrollee’s monthly premium.
The account proposal was limited by age, income, plan type and eligible months. Contributions would be paid monthly for eligible months. That design is not the same as a premium discount at enrollment, and the bill text does not establish that an account balance could be used to pay premiums. People should not assume an HSA deposit would replace the premium support they receive through a tax credit.
Proposed eligibility and contribution amounts
- Age: 18 to 64.
- Income: Household income at or below 700% of the federal poverty line.
- Coverage: A bronze-level qualified health plan or catastrophic plan purchased through an ACA Exchange, along with the bill’s specified eligibility criteria.
- Proposed annual contribution: $1,000 for eligible people ages 18–49 and $1,500 for eligible people ages 50–64, paid monthly for eligible months.
The bill text also proposed appropriating up to $10 billion for the account program in each of fiscal years 2026 and 2027. Those are proposed amounts, not evidence that contributions were funded or paid.
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How that differs from enhanced premium tax credits
Advance premium tax credits (APTCs) reduce the premium a Marketplace enrollee owes by sending the credit to the insurer on the enrollee’s behalf. The enhanced credits increased the assistance available under the ACA’s premium-credit rules. The Cassidy–Crapo bill proposed a different channel and narrower coverage conditions: an account contribution for eligible bronze or catastrophic-plan enrollees, rather than an extension of the enhanced credits.
| Question | Cassidy–Crapo proposal | Enhanced premium tax credits |
|---|---|---|
| Where does federal support go? | A proposed federal contribution to an eligible enrollee’s HSA. | An advance credit paid to the insurer to reduce the enrollee’s premium. |
| Who could qualify? | Under the bill text, people ages 18–64 with household income at or below 700% of the federal poverty line who met the specified criteria and enrolled in an Exchange bronze or catastrophic plan. | Eligibility followed the applicable premium-tax-credit rules; this bill did not extend the enhanced credits. |
| When would the support be available? | Proposed monthly account payments for eligible months. | Premium reduction during coverage, with advance credits reconciled on the enrollee’s tax return. |
| What costs does the design address? | An HSA contribution could help with eligible out-of-pocket costs, subject to account rules; it is not the same as a premium reduction. | The credit directly lowers the premium paid for coverage; deductibles and other out-of-pocket costs are separate. |
The bill’s design alone does not show which approach would leave a particular household better off. That depends on the premium, the enrollee’s eligibility, plan cost-sharing, account rules and actual medical spending. It is not sound to compare the proposed deposit with a household’s former credit as though both paid the same bill.
Other provisions in the introduced bill
The account program was only one part of the Health Care Freedom for Patients Act. The introduced text also proposed:
- Federal funding for ACA cost-sharing reduction payments for plan years beginning in 2027.
- Broader availability of catastrophic plans in the individual market.
- Immigration-status verification provisions involving Medicaid and the Children’s Health Insurance Program (CHIP).
- Restrictions concerning coverage of gender-transition procedures as an Exchange essential health benefit.
The Senate HELP Committee’s December 8 release said the cost-sharing reduction provision would lower benchmark Marketplace premiums by 11%. That figure was the committee’s claim about the proposal, not a measured result. In Senate remarks on December 10, Cassidy argued that the Republican approach would put money in patients’ accounts for out-of-pocket care costs. That is a sponsor’s description of the proposal, not proof of its effects.
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What happened to the enhanced credits and the bill?
The enhanced premium tax credits expired at the end of 2025. In December, the Senate rejected competing partisan health-care bills. On January 8, 2026, the Associated Press reported that the House had passed a three-year extension and sent it to the Senate. That report documents House passage, not enactment; a House vote alone does not establish that the extension became law.
The Associated Press also reported early in 2026 on a KFF analysis projecting an average 114% increase in 2026 premium costs among more than 20 million subsidized ACA enrollees. This was an analysis and projection reported early in the year, not a final measurement of year-end premium costs.
On January 15, 2026, the White House announced a separate “Great Healthcare Plan.” President Donald Trump said its rationale was to stop what he called government “payoffs” to insurers and send money directly to people. That announcement was separate from the Cassidy–Crapo bill. The Associated Press reported that the announcement did not specify proposed payment amounts or establish whether payments would be available to all ACA enrollees or only those selecting bronze or catastrophic coverage.
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IRS guidance says bronze and catastrophic plans became HSA-compatible beginning January 1, 2026, under separate tax legislation. That change concerns whether those plans can be paired with an HSA; it does not mean the Cassidy–Crapo bill’s proposed government-funded account contributions took effect.
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There is also a separate tax-reconciliation change. For tax years after 2025, the IRS says excess advance premium tax credit payments are no longer subject to the former repayment cap and must be repaid in full. Marketplace enrollees should keep their income information current and consult official IRS and HealthCare.gov instructions for their own circumstances.
CMS’s 2027 Exchange final rule separately describes additional verification requirements and lower federal platform user fees than in 2026. Those are later administrative provisions, not part of the Cassidy–Crapo bill.
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