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Floor Speech

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Mr. CASSIDY. Mr. President, I have been coming to the floor to speak about how we can go forward in a way that actually lowers the cost of having health insurance for those who are on the exchanges and begin to build a future where we lower the cost of health insurance and healthcare for everybody whether you are on an ObamaCare exchange or have employer-sponsored insurance or you name it. We know there is going to be a vote--as part of this agreement to open the government-- on what to do about the exchanges; so we need to be thinking and talking about the solutions that are out there that benefit the American people.

Of course, the issue underlying it is that people cannot afford their health insurance. They cannot afford their healthcare. Those are two different things, by the way. The cost of healthcare is what dictates, theoretically, at least, the price of health insurance. If you lower the cost of healthcare, then you lower the price of health insurance. I saw this as a physician when I was practicing in a hospital for the uninsured for 20 years--I should say the uninsured and the poorly insured. There were middle-income people who could not afford their insurance and/or could not afford their healthcare.

So how do we get out of it? Well, first, it is complicated. We have got to be creative, and we have got to abandon set positions. Sometimes we are in this Chamber, and all we do is stick to our guns, and if the other party suggests something, we automatically reject it. We have got to move beyond that, not as, ``Oh, my gosh. If the other side proposes it, I reject it,'' but rather as, ``Wait a second. Let's listen. Is there a solution here that can benefit the American people?''

ObamaCare tried to make and has tried to make healthcare insurance affordable by just throwing billions at it. The problem with that is that it doesn't make healthcare affordable. It just makes the health insurance premium less expensive for those who are on the exchanges. This actually drives up the cost of insurance for some and does nothing about the underlying healthcare costs driving up the premiums for others.

So what is my proposal? I propose, instead of paying insurance companies to manage more of our billions, why don't we trust the American people to manage their own resources or to manage their own care with something which I call a prefunded Federal flexible spending account?

Let's first talk about the enhanced premium tax credit, which is at the center of this discussion. It is just a primer. Let's get the basics.

There are two types of premium tax credits used to fund insurance for those who are on the ObamaCare exchanges. One is the baseline tax credit, in the original ObamaCare law, which helps pay for the premiums for those who earn less than 400 percent of the Federal poverty level, but that didn't control costs. So, during the COVID epidemic, the Biden administration put in something called the enhanced premium tax credit that provides some additional benefits for those less than 400 percent of Federal poverty, but it gave additional benefits for those above 400 percent of Federal poverty, if you will, acknowledging that ObamaCare had not controlled healthcare costs, and premiums on the exchanges for those above 400 percent had become unaffordable.

Let's be clear: The discussion we are having now is not about the baseline premium tax credits; it is about the enhanced premium tax credits, which started under the Biden administration.

So it begs the question: Why were enhanced premium tax credits necessary? Well, as we have said, the cost of healthcare has continued to rise. You can argue, if you are going to an insurance company and you are saying, ``We are going to give you more money if healthcare costs more,'' that they do not have the incentive to help control those healthcare costs.

Now, I am not here to bash insurance companies. They are essential to our society. So I will just put that out there. But if you have the choice of giving the money to the patient for her to manage it or giving it to the insurance company, I think we should give it to the patient.

So the question is: Can we put in programs that lower the cost of healthcare? How long will it be before it takes effect, and what do we do in the interim?

Well, it is too soon this coming year to put in programs to lower the costs of healthcare, but it is not too soon to put in programs that empower patients to manage their costs and give them the money, as opposed to giving it to the health insurance companies, but to do that, we have got to think differently.

So how do we lower costs for the coming year for the individual who is on the exchanges? It is important to realize that the total cost of having health insurance is not just the premium but that it includes the deductible and the copay. So if you can help with the deductible and the copay, that is as effective, or even more effective, than helping with the premiums.

So what I am proposing is something which actually helps the patient become a wise consumer of healthcare, helping her with the premiums and the copays, working with the health insurance policy but in a way which lowers their cost.

Let me be clear: This is not the official Republican position. President Trump has endorsed the concept, but it is not, say, for Leader Thune. But I am the chairman of the Health, Education, Labor, and Pensions Committee, which has jurisdiction over this, and we will be having hearings in the near future to address this. And my motivation is as a Senator and as a doctor who wants to make healthcare more affordable for all Americans.

Let's discuss what I am calling a prefunded flexible spending account. First, here is what we currently have: an enhanced premium tax credit, which is going to take $26 billion next year and give it to insurance companies that tell the patient what she can buy and what she cannot buy.

I have a typo here. I fixed it yesterday, but I have got to fix it once more.

Twenty percent of the money--20 percent of the $26 billion going out the door to help pay for insurance premiums--actually will go for profits and overhead of the insurance company. So let me just change it right here. Again, I had a typo yesterday, and I have a typo today.

Twenty percent of the money we are giving to the insurance companies under the enhanced premium tax credits goes for profit and it goes for administrative overhead. Only 80 percent goes to pay for the insurance premium to pay for healthcare costs for the person who is a recipient.

Let's speak of what I am describing, the prefunded flexible spending account--prefunded because you take the enhanced premium tax credit, instead of giving it to the insurance company, you give it to the individual and her family through a flexible spending account--a flexible spending account which millions of Americans already have.

She can use this money to pay for prescription drugs, for dental work, for medical care, eyeglasses, orthodontia--much more flexibility than through a traditional insurance company.

The key thing is, whereas, if we give this money to the insurance company, 20 percent goes for profit and overhead. If we give it to the patient, 100 percent goes to healthcare that she needs. One hundred percent goes to her family's healthcare needs--100 percent, not 80 percent. This is better value for their healthcare dollar.

Now, who would get it? Every eligible American citizen on the exchange would receive a prefunded flexible spending account equal in value to the enhanced premium tax credit they would have received had the money gone to their insurance company. It doesn't pay for insurance premiums, but it pays for the actual healthcare that they actually need.

I am pleased to say President Trump has tweeted in support of the concept. Of course, I am pleased to be aligned with the President on this. He says he recommends that instead of giving hundreds of billions of dollars--and this is President Trump's rhetoric--to money-sucking insurance companies, the money should ``BE SENT DIRECTLY TO THE PEOPLE SO THEY CAN PURCHASE THEIR OWN, MUCH BETTER HEALTHCARE.''

Notice the caps. That is a President Trump tweet.

I am pleased to be aligned with the President. But for my Democratic colleagues who want a guarantee that whatever we pass will get a vote on the floor of the House of Representatives, this is effectively a guarantee that if we pass a program like this, it can get a vote on the floor of the House of Representatives. If the President asks Speaker Mike Johnson to bring it up for a vote, Speaker Mike Johnson will.

Just imagine, my Democratic colleagues, how do we get something that 100 percent of the money goes for real healthcare; it doesn't go to insurance companies where 20 percent goes for profit and overhead; it is a system already used by millions of Americans, and, may I say, it all but guarantees to get a vote on the floor of the House of Representatives? This tweet gives them that assurance.

Some immediately begin to criticize the President, assuming that he was going to take all the money going for health insurance premiums and put it in one of these flexible spending accounts. That is not true. Go back to what I said earlier. We only are talking about the enhanced premium tax credits which would prefund this flexible spending account. We are not talking about--we are not talking about--the baseline premium tax credits that are part of the original ObamaCare law.

By the way, Republicans want people to have coverage. This doctor who used to take care of the uninsured wants people to have coverage.

The more I discuss this--and this is the fourth or fifth time I have given this talk--I am pleased to say that some of my Democratic colleagues are saying: Hey, we can talk about it. I am not quite there yet, but I see the wisdom of it. I am willing to move forward with it.

And I thank them for that. I want everybody in the Senate to put aside their prejudice, which sometimes is that if one side proposes it, it must be wrong.

I will say to my Democratic colleagues, what I am proposing with the prefunded flexible spending account is actually more closely aligned with how the original authors of the Affordable Care Act wanted that legislation to be implemented.

I find it ironic that some of my Democratic colleagues are rejecting something which is closer to the original bill. But I think they are rejecting it, in part, because of misunderstanding, lack of knowledge, and maybe for some because a Republican is proposing it.

Put that trench warfare mentality behind you. Think about, could this be better for the American people? Can this accomplish the goal of making the possession of health insurance and paying for my family's healthcare more affordable?

For those who think this is too complicated, let me say that 72 percent of Americans who get their health insurance through a Federal employer, a State employer, a local employer--72 percent of us have a flexible spending account. My family and I have a flexible spending account.

Forty-seven percent of Americans who are in private insurance have access to a flexible spending account. It doesn't mean they take it, but it just means they have access.

Millions of Americans are already using flexible spending accounts. What I am proposing, let's just give the same option to people who are on the individual exchanges.

By the way, let me just make the point, my wife and I, our family, we are on the ObamaCare Small Business Exchange. Everybody in Congress is on an ObamaCare Small Business Exchange. I am getting my flexible spending account through an exchange. All we are saying is open up the window just a little bit to allow those who are on the individual exchanges to likewise access that which I am getting through the Small Business Exchange.

This merely extends what is current law for some people on their health plan to extend it to those who are within the individual exchange.

The Federal Government can take the laws, the tools, the vendors, the Department it is already using and implement--implement--a prefunded flexible spending account for those on the individual exchange.

Why is that important? Because that can happen for plan year 2026. I am asking: What are we going to do about the people next year? This is about next year. How can we help those folks signing up for insurance right now for 2026? This brings them benefit right now for 2026.

Let me now kind of go through the differences between the enhanced premium tax credit and a federally funded flexible spending account. This is kind of a money chart, if you will. If you are with me in concept that maybe this could work, hopefully--hopefully--I can convince people who might be watching, my Democratic colleagues who might be listening to give power to the patients instead of giving enhanced premium tax credits to insurance companies.

OK. Who gets the money? Under the enhanced premium tax credit, the insurance company gets the money, and 20 percent of it goes for overhead and for profit. Under the prefunded flexible spending account, a patient and the family controls the money.

What can it be used for? The enhanced premium tax credit, it can be used for insurance premiums. Under the prefunded flexible spending account, it can be used for real care, if you will: dental visits, physician visits, eyeglasses, prescriptions, orthodontia. It has more flexibility than the traditional insurance policy has.

Who makes the decision? Well, the golden rule: He who has the gold makes the rule. Under the enhanced premium tax credit going to insurance companies, the insurance company makes the decision. They decide what care you have, where you get it, and how much you are charged.

When you have a prefunded flexible spending account, the patient makes the difference. The patient makes the decision. She decides where the dollars go. I always use the feminine because women make 95 percent of healthcare decisions for themselves, their family, for their spouse, for their boyfriend. I always chuckle--guys are the stupidest people in the world when it comes to their healthcare, maybe a couple of other things. But the people who care about this are typically women, and so I speak to her.

Does it lower cost? Under the enhanced premium tax credit, there is really minimal incentive for the insurance company to attempt to lower costs; so, therefore, as costs go up, so do premiums. On the other hand, under a prefunded flexible spending account, you empower patients to shop, which drives competition.

One example: I was once stopped on the street by someone who had seen one of my talks. She goes: You talked about using cash or using my flexible spending account or using my health savings account to buy something. There was an MRI order for my son's shoulder. My deductible was $5,000. The MRI was going to cost $2,000. I was going to have to pay $2,000 for the MRI of my son's shoulder.

I said: Wait, do you have a cash price? Well, your cash price is $600. If you don't want to go to the insurance company, your cash price is $600.

Now, the typical ObamaCare plan has a deductible anywhere from $3,000 to $6,800. So if we are talking about an MRI costing $2,000, you are still within the deductible. If you have a flexible spending account, you are not paying for that out of your pocket, you are paying for it with your flexible spending account. And you can ask: What if I give you cash instead, and they will give you the lower price, not the higher price if there is a lower cash price. And there often is.

This turns that woman, that family, into an informed consumer, and that begins to drive down the costs.

This is the essence of giving power to the patients. The patient picks the best deal for her health and the best deal for her family's pocketbook. The prefunded, flexible spending account doesn't treat someone like a dependent of the Federal Government; it treats them as somebody who can make wise decisions for themselves and empowers them to make wiser decisions than the insurance company itself can.

Now, some would ask, how much money does it cost? The first year, depending on how we structure it, it might cost just as much as our enhanced premium tax credits. Why? Because we are going to take the amount of money that would go for the enhanced premium tax credit and put it into a prefunded, flexible spending account.

My Democratic colleagues should like that. They should say: Wait a second. It is still getting the same value--in fact, I would argue, better value because when you give it to the insurance company, 20 percent goes to profit and overhead, and when you give it to the patient, 100 percent goes to real care. But the cost the first year will be about the same.

But I will repeat: The difference is where the money goes. Because it goes 100 percent for real care, there is more value for every Federal dollar.

Once more, it is in the family's vested financial interest to purchase wisely, and that begins to drive down healthcare costs. That, coupled with other reforms in year 2 of this program--in year 2--would begin to reflect itself in lower premiums.

To conclude, here is the choice before us: We can keep paying insurance companies to hide the cost of higher premiums behind confusing bills, rising premiums, and a system which actually raises costs for many or we can give the patient the tool and trust her to pay for her care directly at fair prices, with transparency.

If we will, it puts patients before insurance companies, it encourages competition, it encourages and 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 bureaucracies and insurance companies. Let's invest in our fellow Americans--if you will, invest in you.

This is going to be a little risky. We are doing something different. You will be saying: Oh, I am not just going to be a Democrat. I am not just going to be a Republican. I actually want to try to come together to find a solution to benefit all Americans.

Imagine that. Congress putting partisan politics behind us to come up with a creative solution that actually benefits Americans--a little bit out of our comfort zone. It is what we should be doing every day. I call upon us to do that today.

We have to be willing to take the risk to solve the problem, not be afraid to do something different. We have to be willing to tackle complex problems, not retreat--not retreat--to our trench, which is labeled ``Republican'' or ``Democrat,'' and be afraid to come out to find a creative solution.

I am a Republican, but more than that, I am a doctor who for 20 years tried to care for those who could not afford their healthcare or their health insurance. I invite my 99 colleagues to join me in trying to find affordable healthcare and affordable insurance for our fellow Americans.

Let's be creative. Let's do it. And let's not just reject the proposal because maybe my side or your side proposed it. Let's fix healthcare. Let's give patients the power.

(Mr. HUSTED assumed the Chair.)

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