Editor’s Note: We are publishing the full floor remarks of Senator Bill Cassidy (R–LA), whose proposal for a prefunded federal flexible spending account has drawn support from President Trump, who recently urged that “hundreds of billions of dollars currently being sent to money-sucking insurance companies… be sent directly to the people.”
Cassidy’s speech reads as both economic argument and moral plea: a physician-turned-lawmaker trying to solve the riddle of affordability while still anchored to the market. But the idea of transferring federal subsidies directly to consumers raises its own moral and economic questions.
What happens when the next family’s illness exceeds the balance of their account? Who protects those with chronic or catastrophic conditions when the system assumes we can all “shop” our way to savings?
For all its populist tone, Cassidy’s plan risks making individuals once again responsible for systemic failure. This Journal believes real reform must confront the cost of care itself—not merely redirect who pays the bill.
Donald J. Trump – Truth Social Post
Date: November 8, 2025
Source: truthsocial.com/@realDonaldTrump/115514453574326959
“I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money-sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over.
In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World – ObamaCare!”
Transcript: Senator Bill Cassidy (R–Louisiana)
U.S. Senate Floor — November 7, 2025
Madam President,
I’m going to try and present a way forward for Democrats, Republicans, and Americans out of our current situation with a different proposal than people have already thought of.
Now, the government should not have been shut down for 38 days. And tomorrow we’re going to vote again. And tomorrow the vote will again fail. But Americans—Congress—is frustrated. We need to open the government.
So if, to open the government, we need to talk about healthcare, let’s talk about healthcare. Let’s have a conversation in the family. We have an affordability crisis, and health insurance is part of it.
Now, this is personal to me. I’m a doctor. I practiced in a hospital for the uninsured and the poorly insured for 20 years. And many of those people who came to see me were middle-income Americans who could not afford their medical bills and could not afford insurance. I want to see this solved.
But if we’re going to solve it now, in this present circumstance, we need to move beyond entrenched ways of thinking that have settled us in our camps and refuse to allow us to listen to the other person.
And I thank some of my Democratic colleagues for being here. We’ve got to be creative.
Now, the Affordable Care Act—Obamacare, whatever you want to call it—tried to make healthcare affordable by giving insurance companies more money. The enhanced premium tax credits, or EPTC, are the latest example. Next year, it would send 26 billion dollars to insurers, hoping that families see smaller bills.
But that doesn’t actually make healthcare less expensive. And for some, it actually makes health insurance more expensive if you’re not getting subsidized coverage on the exchange.
So we can do better than just papering over the cost with subsidies.
Instead of paying insurance companies to manage our money, let’s trust Americans with a prefunded flexible savings account, worth as much as the enhanced premium tax credit that they would receive.
Let me repeat that: a prefunded—not out of their salary, but prefunded from the federal taxpayer—equivalent in value to the enhanced premium tax credit that they would receive.
Now, let me make it clear. I’m not speaking for the Republican caucus. I’m not speaking for President Trump. I’m not even speaking as HELP Committee chairman. I’m speaking as a senator and as an American who sees us at an impasse and is trying to think differently about how we can move forward.
So I’m going to present to my fellow Americans an idea that hopefully will move us out of this stalemate and go forward. And I’m going to try and speak as if I’m speaking to American back home.
Here’s the problem. Under the enhanced premium tax credit, if your insurance premium goes up—if the insurance company decides to pay more—they just get more subsidy from the taxpayer. Insurance companies get paid no matter what. And it doesn’t matter how expensive the tab is.
There’s absolutely no incentive to bring the cost down. There’s no transparency as to what the care really costs. And there’s absolutely no reward for the family that goes to a place that’s less expensive.
It’s like putting a bandage on a broken bone—you’re hiding the fracture, but you’re not fixing the broken bone. Let’s fix the broken bone, which is high healthcare costs.
Put simply, the enhanced premium tax credit does not empower patients; it enriches insurance companies.
By the way, they’re important—we need them—but if I have a choice between empowering you, the American, or enriching an insurance company, I, and we, should pick our fellow American.
Now imagine a different type of help. Not paying the insurance company another subsidy, but putting money—prefunded, not out of your salary, but roughly equal to the enhanced premium tax credit—put that into an account that you control.
Every eligible American citizen on the exchange would receive this federally prefunded flexible spending account. It would work like the prepaid health account you use for real-world health expenses.
It would actually have more flexibility than your current insurance proposal. You go to the dentist—it can pay for dental care. You go to the orthodontist—it can pay for your orthodontic care. It can pay for eyeglasses, which typical insurance doesn’t pay for. Prescription drugs, medical supplies, your deductible, your copay. It can pay for it all.
Now, it wouldn’t pay for insurance premiums. This is about you spending directly for your healthcare costs—not about enriching insurance companies. It would pay for the care that families actually use.
That’s what a prefunded flexible spending account actually does.
I keep emphasizing prefunded because when I mention this, people say, “Wait a second, this has to come out of my salary.” No. This would be the money that would go to the enhanced premium tax credit—and instead it goes into this account that you control.
Now, it seems complicated to some. I go and mention it to them and they say, “Boy, this is something different, Bill. This is a great idea—but it’s just too different.”
Seventy-two percent of Americans getting their healthcare through a government entity are offered flexible savings accounts. And forty-seven percent of people getting insurance through their employer are offered FSAs.
This is something used by millions of Americans already.
So what I’m proposing is just to give this option to people on the exchanges.
And by the way, the federal government already offers FSAs to people on the small-business exchange. Members of Congress—we are on the Obamacare small-business exchange. We have the option of choosing an FSA. My family has one.
And the Department of the Treasury already has an office through which they funnel money to pay for these flexible spending accounts that I, as an individual, choose to get.
So what we’re speaking of is just offering to people on the individual exchange that which is already offered to people on the small-business exchange—and paying for it by the same mechanism in which it’s already done through that exchange.
Now, still, there’s going to be some bureaucracy involved. But if there’s any president who can overcome the inertia of the bureaucracy to make it happen by January 1, 2026, it’s Donald J. Trump.
Donald Trump is the man who, when he was told it would take 18 years, ten years—or eighteen months—to come up with a vaccine and a program to prevent COVID transmission, did it in about ten or eleven months.
This president can overcome the inertia. And we have a running start, because the federal government is already doing this.
Let me make clear the key differences between enhanced premium tax credits and federally funded flexible spending accounts.
First, who gets the money? Under the enhanced premium tax credit: insurance companies. Under this proposal: patients and families.
What can it be used for? Premiums under the current system—period, stop, full stop—it goes to the insurance company. Under the FSA: real care—your doctor visit, your deductible, your copay, your dentist, your glasses, your prescriptions.
Who makes the decision? Under the current system: the insurance company. Just wait and fight with them about a pre-authorization. Under the flexible spending account: you make the decision. You have the power.
Lastly, does it lower cost? Under the current system: no. It is pretty clear if we continue to fund insurance companies no matter what they pay, it drives up the costs. In contrast, if you empower the patient, that mother is going to find the most affordable option. It’s been studied. When you give people money they perceive as their own, they hunt for a bargain.
By the way, if they find that the cash price is cheaper than what the insurance company would charge, they will have the option to use this for the cash price.
So we have reforms in here that give the patient even more power. The good thing about that is that as the patient saves money, so does the taxpayer—and that’s a good thing.
The prefunded flexible spending account doesn’t treat people like dependents of the government, as do the enhanced premium tax credits. It treats you like a capable consumer who knows what’s best for your family. You decide where to go for dental work. You decide your pharmacy. You decide whether to pay the cash price or the negotiated price.
Instead of Washington paying insurance companies to manage your day-to-day care, you manage it—with fairness, transparency, and flexibility.
Now, some will ask, “Won’t this cost money?”
Of course. In the first year it will be about the same as the enhanced premium tax credit—and my Democratic colleagues should like that.
But the individual would be getting better value through the federally prefunded FSA because she is spending it on that what she actually needs, instead of up to twenty percent going for overhead, profit, and administrative costs. It isn’t just fiscally responsible—it’s common sense.
Who wouldn’t rather have their money in their own pocket than have an insurance company dictate how they spend it?
So, here’s the choice before us. In conclusion, we can keep paying insurance companies to paper over higher costs behind confusing bills in a system that raises costs for many.
Or we can give Americans the tools and trust our fellow citizens to pay for their care directly at fair prices with transparency.
It puts patients first, not insurers. It encourages competition. It rewards smart choices.
And it begins to make healthcare truly affordable—not by inflating subsidies, but by unleashing the power of the consumer.
Let’s stop writing blank checks to insurance companies. Let’s invest in our fellow Americans.
We have to first open the government. That takes legislation.
But we must be willing to take a risk to solve a problem and not be afraid to do something different.
Right now, I see our chamber hunkering down: “We haven’t solved it, so we’re not going to try anything different. We’ll just wear the other side down until they wave the white flag.”
Now is the time to be creative.
I’m a Republican, but what I just offered is not a Republican solution. It’s not a Democratic solution. It’s an American solution.
Let’s open the government. Let’s work together.
Let’s fix healthcare by giving Americans more power—not the insurance company.
Thank you.