Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I want to recognize Winton P. Lofton, Sr., a proud resident of Winnsboro, LA, who will turn 100 years old on February 17. Winton grew up in Franklin Parish and answered the call to service at just 17 years old, enlisting in the U.S. Navy during World War II. He served for 6 years, traveling tens of thousands of miles from home. Winton is now the sole surviving World War II veteran in Franklin Parish, a living reminder of all the great men and women who fought for our country and secured our freedom. Since returning home, Winton has devoted his life to his community and his church. He and his wife Marie have helped build churches across the country and remain pillars of their local faith community. A devout Southern Baptist, Winton continues to pray every day for our country and its leadership. I am told he is still driving at 100 years young, and that his faith, discipline, and love of country remain as strong as ever. Winton, thank you for your service. You make Louisiana proud. Happy birthday.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise on a very sad occasion, recognizing Jefferson Parish Sheriff's Office Deputy Christopher Ohlmeyer, a motorcycle officer who was just killed in a traffic motor vehicle accident. His death will be felt by his family, his fellow officers, and our entire State. Christopher Ohlmeyer was a great officer, but he was more than the uniform he wore. He was a husband, a father, and a friend. The way that he died, though tragic, is a testament to the way he lived. Deputy Ohlmeyer was struck as he was serving as a motorcycle escort for a funeral procession and was hit by a car from behind. In his final moments, he was serving someone else. I am told that those who did not have a family were invited to be part of his; that he brought people together; that he was deeply committed to serving his community. May we pray for his family, remember his sacrifice, and strive to live our legacy and our lives in whatever way we can, as he did his. With gratitude for Deputy Ohlmeyer's service and remembrance of his life, Mr. President, I ask that we pause for a moment to remember Deputy Ohlmeyer. (Moment of silence.) I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this past Friday, thousands of Americans, young and old, marched peacefully to call attention to the sanctity and inherent value of each life. Their advocacy and passion drive our work on Capitol Hill to protect women and unborn children. I am a doctor, and I learned in medical school that a child's life begins in the womb. Abortion ends that life. Medically, morally, there is no difference in the value of a child, whether she is in her mother's arm or her mother's womb. And as a doctor, I learned the first rule is to do no harm. Chemical abortion drugs are designed to do harm, to eliminate the life of the unborn child, and, at times, to do harm to the child's mother. That is why as chair of the Senate Health, Education, Labor, and Pensions Committee, I focused our first hearing of 2026 on the dangers of the chemical abortion drug mifepristone. Women, families, and unborn children deserve that we do so. I thank Louisiana attorney general Liz Murrill and Dr. Monique Wubbenhorst for sharing the real-life impact abortion drugs have on women and their unborn children. Their testimonies confirm the need to restore the previous in-person dosing requirements that the Biden administration recklessly removed. Chemical abortion drugs are not safe, run-of-the-mill drugs. You shouldn't be able to order them without undergoing a proper medical examination and screening--screening--not just to see the stage of the pregnancy but to make sure that the person who is going to receive the drug is not being coerced to take the drug. Let's first speak about potential side effects. One study showed that 9 in 10 women who take a chemical abortion drug describe their pain as moderate to severe. Half say it was worse than expected. Another study found that 1 in 10 women undergoing mifepristone abortions experience serious adverse events, including hemorrhage, adverse bleeding, sepsis, or infection. Now, that sounds so medical, but this is not about statistics or about how doctors speak; it is about women with real stories. Without the in-person dispensing requirement, pregnant women across the country, including my State of Louisiana, are at risk of being coerced into having an abortion against their will. Attorney General Murrill testified about a 16-year-old girl from Louisiana who was planning to have a gender reveal party, and instead her mother forced her to take the abortion pill. And instead of a gender reveal party, she ended up in the emergency room with complications from taking the medicine. The pill she took was prescribed by a doctor in New York. Now, it violates Louisiana's law that would not have allowed the doctor from New York to prescribe this, but the doctor in New York did not know the age of the fetus within the woman's womb. And she certainly didn't have the opportunity to ask her: Do you really want to take this? If she had asked the young girl, the young lady: Do you really want to take this, she would have found out that she didn't; that it was her mother getting the pill for her, and her mother was coercing her to take the medicine. Now, pregnant women in Louisiana and across the country, again, receive these drugs through the mail, often from somebody out of their State who never does an ultrasound to see the stage of the pregnancy. And this is reckless. The medicine is only approved to be taken within the first 10 weeks of pregnancy. One reason why--I am not an obstetrician--one reason why though is that as the fetus grows inside the womb, at some point the fetus is too large to pass safely through the opening of the womb. The FDA has not reviewed the safety risk of taking it after 10 weeks. Women now are taking it, in the testimony we had, at week 20. This becomes a safety risk for the mother if she cannot pass the fetus, the child stays in her womb, and she is at risk of infection, at risk of, again, going to the emergency room and finding out that she is otherwise sick. By the way, I am a gastroenterologist, but my colleague Dr. Marshall, who is an obstetrician, is also on the HELP Committee. And he pointed out that many women are inaccurately describing how far along their pregnancy is. If you ask a woman, when was your last menstrual cycle, that should date how many weeks she is pregnant. But Dr. Marshall, an obstetrician with decades of clinical practice, will say that it is inexact, and the standard of care is to calculate the gestational age of the child by doing an ultrasound. When the woman knows that the child is further along, she will find out that the child actually has a heartbeat and could live outside the womb, and some will reconsider, on their own volition, whether or not they want to have the abortion. This is why the in-person visit to the doctor is so important. Now, in some cases, these drugs are being mailed from outside of the United States. We don't know what is in them. They are not labeled in compliance with FDA guidelines, and, again, there is no patient-doctor relationship where the pregnant woman can seek needed followup care for the serious adverse events. So let's be clear, if the chemical abortion drug were any other medicine, coming from an unknown country with unknown ingredients, being prescribed by an out-of-state doctor who does not see the patient--it is being taken off label, not in line with FDA guidelines, and sometimes the patient, well-documented, is being coerced into taking it--there should be bipartisan outrage. So why is this drug, this condition any different? How did we get here to the point where abortion pills can be ordered online, mailed, taken with no medical supervision or safeguards with coercion? Think of the girls, the women in abusive relationships, or those who are being trafficked whose voices have been silenced. Now, I was just in an airplane bathroom and, you know, noticing things in the bathroom, and I noticed the sign there: ``Call this number if you are being trafficked.'' It understood that a young person being taken to a Super Bowl-- because oftentimes young people being trafficked are brought to a big event like a Super Bowl--it is happening right now--are going to be on an airplane, and it tells them speak to the flight attendant or call this number if you are being trafficked. And it struck me that we will put a sign in an airplane bathroom--and thank goodness for Southwest Airlines doing that--we will put a sign in a bathroom to inform the young lady of the risk of being trafficked and how to get out of it. But at the same time, we don't do anything about the pimp who might be getting the pill, forcing her to take it to end a pregnancy that resulted from her being trafficked. Shouldn't we tell her the truth of a chemical abortion? Now, as chairman of the HELP Committee, I strongly urge Secretary Robert Kennedy and Commissioner Makary to complete the review of mifepristone that they both promised that they would complete during their confirmation hearings. They both said they would complete it. It has not been completed. Many other things of much less seriousness and much less priority have been completed but not this. And when we are asked, we are told it is in the by-and-by. This should be completed now, not as being prescribed as the FDA said it is being prescribed or should be prescribed, but it is being prescribed in real life, after week 10, long after the FDA has approved for its use. Republican members of my committee and many other Senators expect an answer. At an absolute minimum, the previous in-person safeguards should be restored immediately by the Trump administration. We should go back to the way it was in Trump 1 where, if you are going to get this medication, you must see a doctor and allow that evaluation to occur. And by the way, this is not just Republicans saying this. A recent poll found that 71 percent of Americans, including 67 percent who self- identify as pro-choice, support requiring a doctor's visit for the chemical abortion drug to be prescribed. We should be supporting women with the resources they need to have a happy, healthy pregnancy, and we need to be informing them of the complications that they can have from taking this medicine. And the least we should do is require an in-person visit so that the patient can be evaluated by her doctor so that the doctor can determine that, one, it is safe for the pregnancy, even if you are pro-choice, safe for the woman to take the drug, even if it is not safe for the child, and that the woman is not being coerced to take it. That should be the stance of a pro-life administration. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, sometimes, in Washington, you feel like there is nothing anyone can agree on. But one thing we can all agree on, no matter what your party, healthcare is too expensive. I am a doctor who worked at a hospital in the public hospital system for the working uninsured and poorly insured. And it is not just the poor but middle-income Americans who have a really hard time right now affording their healthcare. There is a little bit of irony here. ObamaCare came into existence, and it was supposed to decrease premiums by $2,400 a year. Since then, premiums have probably risen an aggregate of 100 percent since that law was passed. Part of this--part of this--is waste, fraud, and abuse of taxpayer dollars. So we pay higher premiums, and the taxpayer is getting ripped off as well. Here are just some recent examples. In November, a Federal jury in West Palm Beach convicted two individuals in a $233 million ObamaCare fraudulent enrollment scheme. Earlier this year, the Centers for Medicare and Medicaid Services identified 2.8 million duplicate enrollments across Medicaid and ObamaCare, which wastes an estimated $14 billion annually. Just a few weeks ago, the Government Accountability Office released a report highlighting likely significant fraud in the ObamaCare Marketplace due to lack of proper verification. In this report, by the way, the GAO put up shoddy data on purpose to see if it would be accepted, and it was accepted across the board, even though they came nowhere close to providing the information they were supposed to provide. The American people want lower healthcare costs. They also want us to protect their taxpayer dollars from fraud and abuse. So we need a healthcare system that protects patients and families but doesn't reward a ``get rich quick by any means'' fraudster looking to get an extra buck from the Federal taxpayer. That is why Republicans have focused on a way forward on healthcare that actually lowers costs, fights fraud, and gives power to the patient, not profit to the insurance company, not ill-gotten gains to the criminal. My Democratic colleagues are about to put up a resolution that would do a Congressional Review Act on a recent rule put out by the administration to fight waste, fraud, and abuse. For whatever reason, this resolution wants to fight fighting waste, fraud, and abuse. And if the CRA passes, it will eliminate commonsense measures for waste, fraud, and abuse--to eliminate them, to at least address them--as well as safeguards ensuring that subsidies go to patients who qualify, those who need it to afford coverage. By the way, the resolution being offered by my Democratic colleagues will raise insurance premiums by 5 percent. They are offering a CRA that raises premiums, the effect of, by 5 percent. That is money that a family could use to pay their car note, their flood insurance note, their grocery bill--you name it--rent for their apartment, and, instead, it is going to insurance companies. I don't quite know why my Democratic colleagues are so entrenched in protecting a broken system. They are willing to raise premiums by 5 percent to protect the status quo. All that said, I am a doctor who worked in the public hospital system for over 20 years, trying to bring healthcare to people who otherwise couldn't afford it. Let's work together. Let's find a solution that actually lowers costs, doesn't increase premiums. Let's find a solution that squeezes out waste, eliminates and prosecutes fraud, not a system in which they are rewarded. As a doctor, as a conservative, as an American, as a steward of the Federal taxpayer--when I say Federal taxpayer, I mean you and me and everybody watching and everyone in the Gallery--let's steward that money correctly. I urge my colleagues to reject this resolution and continue with bipartisan, important work to make healthcare more affordable. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise to support Senator Mullin's legislation, the Mikaela Naylon Give Kids a Chance Act. Mr. President, I am a doctor, and people become desperate because of their illness, and they want just one more chance for themselves, their child, whomever. The folks who are most desperate are the parents for their child, and we all know that, because if someone dies when they are 70, it can be tragic, but they have lived 70 good years, and when someone dies when she is 6, she is denied 76 more years. It is the desperation of these families that kind of cries out for this piece of legislation. They want this passed. The goal of this legislation is to get cures for pediatric cancer to the patient more quickly. Now, we have been working on this for several years--Democrats and Republicans--trying to make it so that those families, their desperate pleas are actually heard. And just as the Senator from Oklahoma noted, the legislation was recently renamed to the honorable legacy of Mikaela Naylon, who spent her final days advocating for better pediatric drug research. The irony here is that the objection is going to come out of a genuine concern that people achieve healthcare, a concern I share for increased funding, for funding to be extended for community health centers. I share that concern. But there is no one way to treat the ills, literally the ills of the United States of America. And to think that we can do it all at once, it is just not true. But also to say that you are not going to give a chance for children to have a cure for cancer if you don't get what you want, is just not true. It is selfish. It is tragic. These parents are desperate for this act. Now, this will expand the research and drug development for these pediatric illnesses, and I commit as chairman of the Health, Education, Labor, and Pensions Committee that I will work to pass community health center legislation. I will work to have it well funded. I will not let it sit on the back burner never getting done. There is a commitment from the chairman to work with my Democratic colleague to get it passed this year. If that is the only barrier between offering these children hope, I ask that that not be a barrier. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I know of no further debate on the nomination.

Mr. CASSIDY. I ask for the yeas and nays.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, what we are debating here are two visions of the future of the ObamaCare exchange. Democrats want to cover the cost of health insurance to benefit health insurance companies. And Republicans want to cover the cost of health insurance to benefit patients. Now, I can actually kind of develop that idea. If you look at what insurance--what Democrats want to do, they want to give 100 percent of the money to the insurance companies. And the insurance company, by law, under ObamaCare, can take 20 percent of it for overhead and profit. Eighty percent of it goes to patient care, but, of course, you have got to get your prior authorization and permission for this 80 percent to be spent upon you. On the other hand, the Republican plan is to put the money into the patient's pocketbook so that she has money to pay for the insurance out of pocket. And here, 100 percent of the money she receives goes toward some sort of healthcare or dental care or vision care. By the way, that is a distinction. Under the Democratic plan, the insurance company doesn't cover your dental work, they don't cover the orthodontia for your child, and they don't cover the eyeglasses you need. Under what we are doing, putting it into her pocketbook, for physicians, dentists, drugs, vision care--this is a patient-driven account, of which 100 percent is going to the care she knows she needs. And she does not need to seek permission in order to obtain it. Now, to put a little bit of a point on it, a 50-year-old couple with children 19 and 20 could get as much as $5,000 in their account. Think about what that means for somebody with chronic disease. If you have diabetes, under the Democratic plan, there is a $6,000 deductible; and someone has to pay $6,000 before they begin to get coverage for everything they need for their chronic disease. Under the Republican plan, putting $5,000 for that couple I spoke of earlier, with two children, it is in their pocketbook. They can pay for that which they need for chronic disease. So what is not to like? I would say that the Republican plan meets Americans where they are financially. Most Americans don't have more than $1,000 in their savings account. Let me repeat that: Most Americans don't have $1,000 in their savings account. The Democratic plan would require them to have a deductible and to pay $6,000 before the insurance kicks in. So let's compare the two plans. The red side is the Democratic plan, and the green side is the Republican plan. The Democratic plan is to give 100 percent of the enhanced premium tax credits to insurance companies. The Republican plan is to give the money to the patient-- into her pocket, her pocketbook, her purse--to pay the out-of-pocket for the insurance plan. What could it be used for? Under the Democratic plan, it subsidizes premiums. Under the Republican plan, the patient gets the care she knows she needs--the physician visit, the dental visit, the glasses, the prescriptions. And she doesn't need permission to do it. She does it because she knows she needs it. Who makes the decision? Anyone who has fought with an insurance company over prior authorization knows that the golden rule applies: The one who has the gold makes the rules. And the insurance company makes the rules as to what you can get. And by the way, that does not cover dental, orthodontic work, eyeglasses, and other things. Here, the patient decides. The patient has the power. It is not profit to insurance companies; it is power to the patient. And if she needs eyeglasses, she uses this money that we put into her account to purchase them. If her child needs to go to the dentist for dental cleaning, she can do that. Does it lower costs? Well, if you give the money to the insurance company, clearly, it does not, because since the ObamaCare law passed, costs have exploded. But studies show that if you give the patient the money in her pocketbook, she is going to shop for the best deal. She is going to say: Wait a second. The x ray costs $50 here and $500 there-- and the difference can be that much. I am going to go to the place where it is cheaper. Now, as soon as everybody starts going to the place where it is less expensive, the place that is more expensive lowers its cost. That has been shown empirically to work. The Republican plan gives the patient the power to shop, the power to take advantage of price competition; and that lowers costs. One more thing, how does it work with low-cost bronze plans? Under the tax cuts for working families bill, Republicans passed a law saying that health savings accounts--this kind of putting money in the pocket--can work with a bronze plan. So, if you give the money to the bronze plan, which is permitted under current law, the patient now has the ability to purchase a cheaper plan on the exchange, saving thousands of dollars relative to the plan that Democrats want to force somebody to buy. And what we have seen under the current system is that there are all kinds of fraud and there are all kinds of unauthorized enrollment, costing taxpayers billions of dollars. Now, it has been said that somehow Republicans are supporting junk insurance. And you have got to laugh. Mr. President, you have got to laugh. Republicans are using the same plans on ObamaCare that Democrats fought for. We are merely taking the framework, set up on a unanimous partisan vote by Democrats, to create these plans on ObamaCare, and that is the one we are using. So for some to call those junk plans, it is kind of like saying: We gave the American people junk. I would argue that the Republican Party is making these better. Look at this. Under the Democratic plan, there is a $6,000 deductible. Imagine the housewife who has to take her child to the urgent care center and knows she doesn't have the money. This is a cartoon, but in that cartoon, there is real stress and anxiety for that mama who cannot afford the care she knows her daughter needs. Look at this one, the Republican plan. She has got money in her pocket. She has got money in her account. She has got money in her pocket for the insurance out-of-pocket. And if she starts off with money in her purse to pay for that need, why can't people see that is where the American people are? If the average American family has less than $1,000 to spend and our plan puts thousands in their account to pay for the healthcare that they know they need, what is the objection to that? Now, by the way, I think you finally found the objection. There is a concern that Republicans are somehow interjecting abortion politics. And I will point out that Democrats have voted for appropriations bills with Hyde protections since the 1970s. For over four decades, Democrats have voted for language on this issue, and suddenly--suddenly--they are shocked. So instead of giving this patient the money she needs, it is going to be sacrificed on the altar of abortion politics. I say: Go with her. I say: Support her. Let's go to the last slide, please. We need to make healthcare affordable again. One, we know the Democratic extension will not pass. It is going to stick people with $6,000 deductibles. It does nothing for fraud. It is not a solution. What we need--by the way, I am also going to say this: I am, obviously, saying we don't need the Democratic solution. My Democratic friends will say they don't like the Republican solution. Let me argue that we try and get an American solution, not an R, not a D, but an A solution. And if we do so, let's give power to the patient, not profit to the insurance company. Let's make healthcare affordable again. With that, I yield the floor.

Mr. CASSIDY. Would the Senator yield?

Mr. CASSIDY. I didn't show the poster, but in our proposal taking the 50-year-old couple with 2 kids, 19 and 20, their family would get $5,000 in their account, and the net deductible would be less than the silver plan the Democrats want. And the policy premium would be $6,000 less a year. So if the plan, that my good friend the minority whip is saying is the better plan, has a higher net deductible, that, I don't think, works for the gentleman's knee replacement. And the family $5,000 deductible can be applied, so you would have $5,000 top. I have taken too much time, but thank you for yielding.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this well-meaning CRA is not needed. For decades, Congress has allowed Agencies to fast-track regulations on bureaucratic topics that do not impact the public. The policy that is sought to be overturned merely aligns HHS policy with this longstanding exemption. It does not change the process for major regulations that impact the public. The courts have weighed in repeatedly on Agency processes for issuing regulations. Fast-track procedures can only be used in a narrow set of circumstances. If there is a concern about the HHS policy, the goal should be to change the law, not pass this CRA. There has been an implication that reductions in force would have gone through rulemaking if HHS still had the Richardson waiver in place. That is actually not true. The reductions in force are governed by an Office of Personnel Management regulation implemented by HHS. I yield the floor. Vote on Motion

Mr. CASSIDY

Mr. CASSIDY. Mr. President, tomorrow, we are going to vote on two different visions of how to cover the cost of health insurance on the ObamaCare exchanges. Democrats want to cover the cost of health insurance to benefit insurance companies. I will tell you why I am saying that--because I can make that case. Republicans want to cover the cost of health insurance for the actual person who is buying the insurance--the patient, if you will. That is the difference between the Democratic plan and the Republican Health Care Freedom for Patients Act. So let me just kind of build that out. How do we make healthcare affordable again? First, the Democrats want people to pay $6,000 out of pocket before the insurance kicks in. The Republicans want to put thousands of dollars in the patient's pocket so she has that to pay before she actually gets into her deductible. Let me demonstrate with this chart. The Democratic plan is to give 100 percent of the money to the insurance company of which the insurance company takes 20 percent for profit and overhead. Then it uses the rest of the 80 percent to pay for the insurance that they think--that they agree--the patient needs. Our plan puts the money in the patient's purse, her pocketbook, her wallet. One hundred percent of the money in there is used for the care she knows she needs. She doesn't have to get permission from the insurance company. She knows she needs it. She can see her doctor, her dentist. She can get her pharmaceuticals. She can get eyeglasses, dental care, and orthodontia. That is a patient-driven account. This is the plan that Senator Crapo--the Finance chairman--and I propose. So let's compare the two plans. Again, they are two competing visions, two different ways, and I would argue that the Democratic plan principally benefits insurance companies and that the Republican plan is there to benefit the patient. Let's look at this. The Democrats just want to extend the enhanced premium tax credits. Who gets the money? Insurance companies. Under our program, where the money goes to the patients, the patients and their families get it. What can it be used for? Of the enhanced premium tax credit that the Democrats wish to extend, there are no changes whatsoever--3 years of subsidized premiums. That goes to the insurance company. On our side, the money that the patient gets in that account--the money that we put into her pocket so she can pay the out-of-pocket for the insurance company--goes for real care: the dentist, the physician, the glasses, the prescriptions. Who makes the decisions? Under the Democratic plan, the insurance companies make the decision. Under our plan, the patient makes the decision. We give power to the patient, not profit to the insurance company. Does it lower costs? Clearly not. What we have seen since ObamaCare was passed is costs explode. We continue to have the healthcare inflation we are looking at now. But if we empower the patient and if we give her the money and we say ``The more careful you are spending this money, the more that money is going to stretch,'' I can promise you, she is going to be like every other responsible wife, mother, keeper of the family wallet: She is going shop. Wait, my x ray is $50 here. No, my x ray is $500 there. I am going where it is $50. She will make the wise financial decision for her family. How does it work with low-cost bronze plans? Here, under the Democratic plan, we have just heard Senator Crapo point out how much fraud there has been with this system that we are currently under. Under the patient-driven account, the money goes into a health savings account--into your wallet, if you will--which is connected with your bronze, and the mechanisms by which we set that up make sure we cut out that fraud. Our bill goes after that fraud; their bill tolerates it. There is nothing in their legislation to stop the fraudulent stealing of billions of dollars of taxpayers' money. What it does do is it continues payments to insurance companies that take 20 percent of that money for overhead and profit, whereas under our plan, the money we give to the patient--100 percent goes to the care she knows she needs. That is the plan Republicans are proposing. To put it differently, under the Republican plan, there is power to the patient. Under the Democratic plan, there is profit and power to the insurance company. Under the Republican plan, the patient uses the healthcare money in her wallet to purchase the care she knows she needs. Under the Democratic plan, you go to the insurance company and plead: Please, baby, please can I get permission to get the care I know I need? The Republican plan meets the American people where they are financially. Studies show that only like a--that most families have less than $1,000 worth of savings. Under our plan, we recognize that, and we put money in their wallet, pocketbook, or purse so that they can pay for the care they need before they go into their deductible. Like this. This is a new poster for people who have heard my talk before. This is the Democratic plan. You get a $6,000 deductible, and that is what you feel like, that woman right there when she is stressed because she doesn't have the money to pay for the care her family needs. Here in her health savings account, the money is, if you will, in her purse, and when the doctor says ``You need this prescription for you son's earache,'' she has the money to pay for it right off the bat. The Democratic plan brings financial stress--profits to the insurance company; stress to the patient. The Republican plan--money in the pocket to pay for the out-of-pocket for the insurance plan. Now, by the way, this plan in which we put money in the pocket of the patient to pay for the out-of-pocket of her insurance policy the Democratic leader has called a junk plan. Now, pause for a second. Democrats put that plan into place. Democrats actually put these plans on the ObamaCare exchange. He is calling a junk plan that which they have been preserving for the last 10 years, swearing up and down that it meets the needs of the American people. All Republicans have done is added to it something called a health savings account, if you will, money in the patient's purse, pocketbook, or wallet to pay for the out-of-pocket associated with this plan. To call this a junk plan just shows that the Democratic leader does not know what we are talking about or that hypocritically he has been defending an ObamaCare law which created this very plan. By the way, I was smiling last night when I saw that the New York Times mimicked this talking point like a Democratic Party organ. What is junk? That for a family of four--two parents in their fifties, children 18 and 19--that they get $5,000 a year? Think about that--$5,000 a year for that family I just described to pay for their initial healthcare expenses. Think about if one of those children had diabetes--chronic care. Under our plan, they have $5,000 to help pay for that chronic care right off the bat. Under the Democratic plan, with a $6,000 deductible, you are paying for that out of pocket, and that is what your face looks like because you cannot afford it. Our plan relieves the stress. Now, next, the minority leader says that he wants to reject all these benefits. He wants to continue to send 100 percent of the money to the insurance company, which takes 20 percent for profit and overhead, as opposed to sending the money to the patient for her purse, wallet, or pocketbook so that she has money in the pocketbook to pay the out- of-pocket from the insurance company. He is defending that with a $6,000 deductible because he says that Republicans want to prevent taxpayer-funded abortions. He wants to have taxpayer-funded abortions apparently, and Republicans, consistent with the American will, as we have for decades, think that we should not do that. Somehow, he is making out like this is a new development. Well, just for the sake of the American people, the so-called Hyde amendment, which prevents Federal dollars from being spent on abortion, has been agreed to by Democrats on annual appropriations bills since the 1970s. They have been agreeing to this for 50 years, and all of a sudden, that is being used as a rationale to send 100 percent of the money to the insurance companies, which take 20 percent of it for profit and overhead, as opposed to sending thousands of dollars to the patient for her to pay first-dollar coverage, to have it in her pocketbook to pay the out-of-pocket for her insurance plan. I don't want this to seem partisan. I have been saying ``Republican'' and ``Democrat,'' but let me say that we should not have a Republican plan; we should not have a Democratic plan; we should have an American plan. This is a cartoon representing an American, but think of the person you know. Think of the person you graduated from high school with--good people. Good people. Several kids. Trying to make ends meet. They don't have a lot of money. But good people. That is who I am talking about. Let's just separate this from R versus D. What about the people we are supposed to care about who cannot afford a $6,000 deductible but would love to have thousands of dollars in their purse, pocketbook, or wallet to pay for the out-of-pocket costs associated with that insurance plan? Isn't that where we want to be? Now, just to put a face on this--maybe some numbers, I should say. This is real. This is off healthcare.gov from 2026, this coming year. A family of four, a couple in their fifties with two children, 20 and 21; 500 percent of the Federal poverty level--about $160,000, I think, per year, OK? Under our plan, they would be able to get a bronze plan as opposed to a silver, which saves them roughly $6,000 per year. The amount in their health savings account--if you will, in their pocketbook, purse, or wallet, in their pocketbook to pay the out-of- pocket costs of the insurance plan--would be $5,000. Under what Democrats are insisting they must buy--will not give them an option--they have zero dollars to pay toward that $6,000 deductible. And the net deductible--because they say: Oh, my gosh, if you get a plan with a lower premium, your deductible is higher. Because of the money that would be going into the health savings account, the net deductible is cheaper with a cheaper policy under the Republican plan. Under the Democratic plan, the net deductible is higher. Let me add one more thing. Senator Crapo spoke about the incredible amount of fraud associated with the current implementation of ObamaCare, and the Democratic leader wants a straight-up, clean reauthorization for 3 years. He does not want to fight that fraud. Whatever bill was put up in the past, that is not what he is talking about now. He is talking about right now not only 100 percent of the money going to the insurance company with $6,000 deductibles; he is talking about continuing a system that is rife with fraud. If you are at home--no. If you are at work and you are working so hard and you are paying taxes to support our country and you hear there is fraud, it should drive you crazy. It drives me crazy. Why won't our Democratic colleagues join us in doing things to stop that fraud? I have never seen a party so committed to generating profits for insurance companies as what I am seeing right now. Let's cut that fraud. Let's put the money in the purse, pocketbook, or wallet of the American citizen to give her money to pay for the out- of-pocket costs of the insurance company. Don't stick them with a $6,000 deductible. Let's give power to the patient, not profit to the insurance company. I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I have nine requests for committees to meet during today's session of the Senate. They have the approval of the Majority and Minority Leaders. Pursuant to rule XXVI, paragraph 5(a), of the Standing Rules of the Senate, the following committees are authorized to meet during today's session of the Senate:

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this is a really interesting debate. Right now, Democrats are advocating to send $26 billion to insurance companies so that you subsidize plans--silver-level plans--which have a $6,000 deductible. I have asked people who have asked me about this: Do you have $6,000 in your bank account to spend on healthcare before the insurance actually kicks in? Not one has yet raised his hand. I think some of those advocating for this among Democrats just don't realize the financial situation American families are in when we ask them to pay $6,000 before the insurance kicks in--$6,000 beyond the premium that they are paying for their health insurance. So people-- patients--are going to see their doctors, and they can't afford the deductible. When I was practicing, I would say to my patients: What about this procedure? this test? this medicine? Doctor, I am in my deductible. I cannot afford that. So, to have a $6,000 deductible is, for many, the same as having no insurance at all. By the way, it goes without saying, under your traditional medical insurance plan, you don't get eyeglasses, and you don't get your teeth cleaned. Why not, instead of sending 100 percent of the money to the insurance company, of which they take 20 percent for profit and overhead, we send 100 percent to the patient. Then she can spend it on the services that she knows she needs. This is kind of, if you will, the Republican plan, and I will tilt it this way so those in the audience can see because they represent the American people. Under the Democratic plan, they want to send 100 percent of the money to the insurance company that takes 20 percent for profit and overhead, and only 80 percent goes for patient care, but to get that 80 percent, you have got to ask permission. We, the Republicans, want to give the money to the patient so that she can pay for her physician, her dentist, her drugs, her eyeglasses. She gets the money, and she can get the healthcare that she knows she needs as opposed to the healthcare that she gets permission from her insurance company to get. To put it simply, we want power to the patient, not profit to the insurance company. Now, the other side is going to claim: ``Oh, no. Wait. No, no, no, no''; that, in some way, the plan we are proposing does not work out financially for the American people. You are not lowering their premiums. You are not helping them with their first-dollar cost. So here is a prospective plan for my State for a couple 55 years old, with a 20- and 21-year-old on their insurance policy, at 500 percent of the Federal poverty level. The bronze plan is $2,250 per month. The silver plan is significantly more expensive. It is $6,000 more expensive a year. It is almost $3,000. Under our plan, everybody up to age 49 gets $1,000 into their health savings account. If it is a family account, it goes into the family account, and those over 49 get $1,500. So this family of four, with those ages, gets $5,000 into their health savings account. It is $5,000 so that, when I go to the doctor and I have got an earache and I need medicine, the health savings account pays for the doctor's visit, and the health savings account pays for the medicine. Contrast that with what Democrats want. They want a plan which is $6,000 more a month. The net deductible is higher, and you don't have $5,000 to begin paying for your medical bill. You have got no money whatsoever, and on that first trip to the doctor, you are paying out of your purse; you are paying out of your pocketbook. This is the plan that works for the American people? ``Not.'' When I was a physician--but no. As somebody who had three children, this is not the plan that would have worked for my family. Republicans are trying to meet the American people where we know they are, not some theoretical ``oh, that is where they should be.'' Most Americans don't have $6,000 to pay for healthcare before they get it billed by the insurance. So let's do just kind of a side-by-side comparison. Here is the difference between the two accounts. Who gets the money? Under their plan, the insurance companies. Under our plan, the patients and families. What can the money be used for? Well, here it is subsidized premiums, which means that the insurance company gets it and takes 20 percent for the deductible and copay. Under our plan, you can use it for your doctor visit, your x rays, to see your dentist, your glasses, or your prescriptions. This is real medical care, not something the insurance company permits you to have. Who makes the decision? Under their plan, the insurance company. Under our plan, power to the patient. We want that patient--we want that mama; we want that wife because they are the ones who always make the decisions on healthcare--to be the one who has the power. Contributes to lower cost? Under their plan, no, because it goes to the insurance company that continues to pay those higher rates. To the patient, if you give her this money, you have got $5,000 to spend it wisely. She is going to say: Wait a second. The x ray is $150 here and $500 there. I am going to where it is cheaper, not more expensive. I can tell you, when that begins to happen, the people who are more expensive will begin to lower their prices. This is a plan that by sending it to the patient for real care, to the patients with the power, you empower the patient to shop, driving competition and lowering healthcare costs. We just heard from Senator Crapo. Under the plan that my Democratic colleagues support, we have seen widespread fraud and unauthorized enrollment. Under our plan, if you have got a health savings account, it is pretty easy. I just signed up for a similar type of account on my healthcare. You have got to show who you are. It is not really hard. It took me about 5 minutes, but the banks that manage this money are going to require that you identify that you are a real person. This is an anti-fraud program. What is not to like? The money goes to the patient, not to the insurance company. It is used for real care. It gives the patient the power to shop and find a better price, which lowers healthcare costs, and along the way, we have mechanisms which cut out the fraud. This should be the basis of a bipartisan deal. So I have called some of my Democratic colleagues. Let me start over. I have been asked by the press: Why wouldn't Democrats want this? I mean, why would they not want 100 percent of the money going to the patient instead of 100 percent of it going to the insurance company, and the insurance company takes 20 percent for profit and for overhead? Why wouldn't Democrats want to give power to the patient so that she can shop for a better deal, instilling competition, which ultimately lowers costs? Why would Democrats not want a system which begins to squeeze out the fraud that Senator Crapo pointed out is so rampant in this program? I just shrugged my shoulders. I am not sure. As I say in my Spanish language class, ``digame.'' I am not quite sure I follow. Then I heard Minority Leader Schumer explain that this is all about Hyde. They are afraid that our plan will not allow abortions, so they are going to continue to send the money to the insurance companies, subsidizing premiums, profit for the insurance companies, contributing to healthcare inflation and with unchecked fraud--all because of what is called the Hyde amendment. By the way, what is the Hyde amendment? For those watching, the Federal Government, consistent with the will of the American people, has made a decision not to spend Federal dollars to pay for abortion. That is what the Hyde amendment is. For most Republicans, that is an important part of our position, and Democrats have decided that they are willing to forgo all of these advantages in order to protect insurance companies paying for abortion. Let me tell you the ultimate irony in that. When ObamaCare passed, President Obama made a deal in which these plans were not supposed to pay for abortion. Section 1303 of the ObamaCare law, if I remember correctly, said that these dollars are not supposed to pay for abortion. Democrats are defending dollars paying for abortion. Either they are going to acknowledge that insurance companies are ignoring the law, in which case--wait--we are going to enable insurance companies to break the law or they are attempting to introduce a source of funding for abortion that President Obama himself did not include. Now, if your rationale is to send 100 percent to the insurance companies instead of 100 percent to the patient to subsidize premiums instead of paying for real doctor care--they let the insurance companies make the decision instead of the patient--and to not contribute to lowering costs versus empowering patients to shop for a better deal and, with competition, lowering healthcare costs--and, by the way, did I point out they can get a lower premium with $5,000 in a health savings account for that family that otherwise could not afford care because you are trying to introduce a new right to abortion in a Federal insurance policy? Be honest with the American people. Either the original ObamaCare law is being ignored or you are trying to establish a new right. I have said before that we need to find a way that the American people can afford their insurance. Absolutely, we need to find that way. I have said repeatedly I don't want a Republican plan; I don't want a Democratic plan. I want an American plan, a plan that works for our fellow Americans so that they can afford the insurance that this Republican absolutely wants them to have, but we have got to do it in a way in which they have real insurance, not a policy with a $6,000 deductible, with lots of fraud associated with it, and which does nothing to achieve the goals that we know we need. I don't see why Republicans merely pointing out that under the ObamaCare law this was not to pay for abortion in the first place should be the reason that we cannot protect Americans from these $6,000 deductibles. With that, I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, we just had a shutdown over something that the American people I am not quite sure understand, but what they do understand is that they cannot afford their health insurance. They cannot, if you will, afford the cost of being insured. Prices of health insurance and of healthcare are up for everybody. It is not sustainable, and they are looking to us--they are looking to Congress-- for solutions. As a physician, as a doctor, I have seen it firsthand. I have seen patients come to see me with insurance, but they could not afford their deductibles. I have seen people who could not afford their insurance and who therefore take the risk that they will not get sick. We should not have that in our country. In July, the Health, Education, Labor, and Pensions Committee--the HELP Committee, which I chair--discussed affordability across the entire commercial insurance market, trying to find out why costs are going up so high when you are buying your insurance through your employer or, as the employer, buying the insurance for the employee. But it doesn't matter. If you are on the individual market or if you are on the small business market, you are paying more, and because of increasing healthcare costs, insurance premiums are climbing as well. Now let's go to the ObamaCare exchanges because the shutdown we just had for over 40 days was related to the fact that subsidies are ending on the ObamaCare exchanges. A little bit of history: During the COVID pandemic, health insurance premiums were going up so much that Democrats passed extended, temporary, enhanced premium tax credits--if you will, EPTCs--which helped give more money on top of the original ObamaCare subsidies to help people afford their premiums. The way it works is they didn't give the money to the patient, to the individual, to our fellow American; they gave the money to highly consolidated insurance companies, which take 20 percent of that for profit and overhead. Now, I am not knocking insurance companies. We all have insurance for our cars, for flood insurance, for property and casualty, et cetera. I am just pointing out that they do take 20 percent of what we give them for profit and overhead. By giving the money to the insurance companies, we are not actually lowering the cost of the premium; we are just papering over it with subsidies. Somebody is paying for that. It is the taxpayer who is paying for that. The premium is going up. Yes, the person getting the insurance pays less, but we the taxpayers are paying for it. There is no free lunch when it comes to this. The enhanced premium tax credits don't lower the cost of healthcare, but they are a bandaid on a broken bone. By the way, we can prove this. In 2014, taxpayers covered 68 percent of an ObamaCare exchange enrollee's premiums. By 2020, 60 percent had become 80 percent, meaning that is how much the taxpayer was subsidizing. From 2021 to 2025--the era of the enhanced premium tax credits--the taxpayers' share of subsidizing the premiums on the exchanges grew to 93 percent. What started off as 68 percent has become 93 percent this year. Yet, despite all this money--let me repeat--the actual premium never decreased; it is just that the taxpayers were paying more of it for our fellow Americans. Now, somebody is paying. You and I are paying it. By the way, if you are not getting extra money, if you are paying for it on your own, you are still paying those higher and higher rates. If I were that person individually insured who was not getting the subsidy when everyone else was but my tax dollars were going to subsidize other people, I would feel totally taken advantage of. You are paying for others to get cheaper insurance, but you are paying more because nobody is addressing the higher costs of healthcare. We should be fair to our fellow Americans who can't afford their premiums. We should be fair to our fellow Americans who are not getting subsidies. So what do we have to do? Well, let's go after the root cause of what is causing the healthcare costs to rise. Let's find out why that is, and let's attempt to decrease the cost of healthcare. It is hard, but I think there are practical solutions that are implementable that could actually do that. But that is only one part of the conversation. The second part of the conversation is, what do we do about January 1, 2026, when the tax credits that the Democrats passed are set to expire at the end of this year? What do we do for those Americans who are in some cases facing $33,000-a-year premiums who have a salary of $90,000? What do we do for them? Some people just want to continue the subsidies as they are--the status quo: Let's continue the subsidies for 3 more years. And, yes, the premiums will continue to rise. Yes, it will require taxpayers to subsidize more and more. By the way, the policies we are buying have $6,000 deductibles. They want to continue that status quo. Well, I can tell you that I am not interested in the status quo. As a physician, I can tell you that putting a bandaid over a broken bone doesn't work. And the Republicans are absolutely interested in finding a solution that can make healthcare and health insurance more affordable beginning on January 1, 2026, but going on beyond that. So what can we do for January 1, 2026? This is where I think we are headed: If Congress does what it always does, Democrats are going to put up a bill, and it is going to fail. They are going to put up a bill, and they are going to know it is going to fail. The Republicans will put up a bill, and it will fail, and everyone will know that that bill will fail too. Then premiums will rise on January 1, 2026. The American people who are looking to Congress for a solution will find two bills side by side, neither of which passes and both of which we know will fail, and their premiums will go up. That should not be an option. I suggest that we find a solution--not a Republican solution, not a Democratic solution, but an American solution. Put differently, not an R, not a D, but an A solution. There are ideas out there on the right and the left that are big ideas, good ideas, or bad ideas, but they are going to take a long time to discuss, debate, figure out, and implement. We have to be focused on January 1, 2026, and that means we have to build on what we already have. Now, folks may not like what we already have, but we have to focus on getting something done in 3 weeks. So we have two choices: Do nothing and accept the premise that no deal is possible, that the enhanced premium tax credits go away, that there are no reforms to a failing system, that a Democratic bill and a Republican bill both fail like so much fails in Congress, and that the American people are not served--that is one option--or we can roll up our sleeves and figure out something we can all live with. I think that there is, if you will, such a sweet spot, one in which Congress appropriates funds equivalent--roughly equivalent--to what we would spend on the enhanced premium tax credits, but instead of 100 percent of this money going to insurance companies, which take 20 percent of it for their deductibles and copays, we give 100 percent almost to the patient, to our fellow American, in an account that she controls and can use as she wishes. So I am proposing not to continue--I will put it up there for our guests in the audience. Good to see you all. If we just keep doing what we have been doing for the last 4 years, we send $26 billion to the insurance companies, which take 20 percent of it for profit and for overhead--that is under the ObamaCare law that they can take that 20 percent--or we can send 100 percent to an account that the patient controls. She makes the decision on her doctor, her dentist, and on some things that insurance doesn't pay for: eye care, dental care, orthodonture. She makes the decision. She gets the healthcare she knows she needs as opposed to the healthcare the insurance company gives her permission to have. Put differently, giving her the money gives power to the patient. That is where we should be. What Democrat wants to give 100 percent of the money to the insurance companies for them to take 20 percent for profit and overhead? What Republican does not want to give power to the patient by putting money in her account for her to use--I am chuckling, and I will tell you why in a second--as she sees fit? Sometimes people say--and there are a lot of men up in the audience who are chuckling with me. Some people say: Well, why do you use the feminine when you speak about this? Because women make 85 percent of the decisions in healthcare, and we can trust her to make a decision which is good for her family's health and which is good for her purse, which is good for her pocketbook. Let's have faith in her to make the wise decision for her family as opposed to having to go to the insurance company, which returns roughly 80 percent of it back but takes 20 percent for profit and overhead. Give power to the patient. Now, you can do this because under ObamaCare, you can take a credit which goes to a more expensive healthcare policy or you can apply it to a less expensive policy. That gives you savings, and those savings you can split up between all of the eligible people on the exchanges into their health savings accounts. It would be to the patient's financial advantage to take a cheaper plan but to have the health savings account to help pay for her expenses. By the way, the health savings account, it has been shown, empowers, encourages somebody to make wise decisions. If she knows that ``I can get the x ray here for $500 or down the street for $2,500,'' she is going to go where she gets it for $500. That begins to lower costs because the people who are more expensive will lower their costs. She, the woman in charge of this, is going to drive lower costs across the healthcare economy. Some folks say: Wait a second. Health savings accounts--aren't those just for rich people? No. One, I don't think they are in general, but in this case, we are prefunding them. It doesn't matter what your income is. You get more money. The Federal Government, instead of sending it to the insurance company, puts it into the account for you. You get more money. By the way, if you do it the way I would like to set it up, if you are less well-off, you get more money. If you are a little bit older, you get more money because--I hate to say it--when you get a little bit older, your healthcare costs go up. If you have a bunch of kids, you get a little bit more money, too, because taking a child to the emergency room can be expensive. We can make this work for the American family as opposed to the American family working to get the insurance company to approve the care they know they need. My plan does not take away coverage. It doesn't touch the original ObamaCare tax credits. The patients need a solution that reduces their costs of being insured, not just the cost of the premium. There are a lot of other issues to address. I am pro-life. There are some pro-life issues. But I have found that if we come together in a well-meaning way and work out a way that we can keep the American people from getting stuck with a high healthcare cost, treat their tax dollars with respect, and ideally lower the cost of the program, we can work out other issues. President Trump endorses this approach. President Trump has said he would rather not give money to the insurance companies. He would rather give it to the people. Actually, he said: Don't give the money to the money-sucking insurance companies; give it to the patient--or something like that. President Trump has a way with words. So, however you say it, let's give the patient the power. Because President Trump endorses it, though, I do think that Republicans will by and large support it, that there will be a vote in the House of Representatives, and that there is enough in here that Democrats want that Democrats can find some way to embrace it. The American people want something to pass. Let's work to find something that can pass. Let's give power to the patient, not profit to the insurance company. Let's make healthcare affordable again. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I ask unanimous consent that the Senate action with respect to H.R. 3174 be vitiated.

Mr. CASSIDY

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. I yield the floor. (Mr. HUSTED assumed the Chair.)

Mr. CASSIDY

Mr. CASSIDY. Mr. President, there are reports that the government will be reopened tonight or tomorrow morning, and all I can say is, it is about time. It has been 40 days too long. But we also know there is going to be some vote in the not-so-distant future on what do we do about high health insurance costs and, hopefully, another vote as to what can we do about the high healthcare costs that are driving the high health insurance costs. And we need to talk now. We can't just like come up on the vote and suddenly have a solution. Rather, people need to be thinking about it between now and then, about the solutions that benefit the American people. Clearly, we have a problem with the affordability of healthcare and of health insurance, and, of course, that is related. And this is something that, in my professional life as a physician, I addressed over 20-some years, before entering political life. I practiced in a public hospital for the uninsured for over two decades, seeing middle-income and lower income Americans--fellow Americans--who, for whatever reason, couldn't afford their insurance or couldn't afford their healthcare, and they came to the hospital for the uninsured. So health insurance, healthcare costs--very complicated--and we have got to be a little more creative than just the Federal Government throwing money at them. ObamaCare tried to do that, and it has not worked. The enhanced premium tax credit, or the EPTC, is the latest example. It was a COVID program unrelated to the original ObamaCare program, and the enhanced premium tax credits sent billions of tax dollars straight to the insurers, hoping that families would see smaller bills. But you know, it might paper money over the high health insurance costs, but it did nothing for healthcare costs, and, by the way, it also made health insurance more expensive for many. So I think we can do better than just hiding the costs of high healthcare and high health insurance costs by the Federal Government spending billions more. So an idea that I am asking my colleagues and the American people to consider is a prefunded Federal flexible spending account. Now, let me make a couple of things clear. First, I am not speaking for John Thune, the majority leader. I am not speaking for Donald Trump. In fact, although I was the chairman of the Health, Education, Labor, and Pensions Committee, I am more speaking as Bill Cassidy, a doctor that worked with the uninsured for 20 years and is now representing the great State of Louisiana. And I am speaking to my colleagues and to fellow Americans, asking all of us to put aside our prejudice, to put aside our kind of: Oh, no, gosh, the Republicans are proposing it or the Democrats are proposing it; so, therefore, I must oppose. No, to actually come together in good faith to try and find a solution--so let me first describe what I am speaking of. First, there are two types of tax credits on the Affordable Care Act exchange--the ObamaCare exchanges. And I am going into this for a reason. One is the baseline tax credit that was enacted into law in 2010 that lowers premium costs for those less than 400 percent of Federal poverty. So the first one started, in 2010, under ObamaCare, the original legislation. It goes to people making less than 400 percent of Federal poverty. During COVID, there was another sum added called the enhanced premium tax credit, and that gives some extra benefits to those less than 400 percent of Federal poverty level but began to cover people over 400 percent of Federal poverty level--so two pots of money. One pot dates from 2010, part of the original Affordable Care Act law, and the other passed by the Biden administration during the COVID pandemic, benefitting those above 400 percent of Federal poverty. What I am proposing does not touch that baseline. What I am about to propose does not touch the moneys that were set aside in 2010 under the Affordable Care Act. Why do I say that? President Trump endorsed the concept I will be speaking of, and one of my Democratic colleagues said: Wait. Are you going to give all the insurance money for these accounts? No. Time out. Absolutely not. We are going to leave that portion which was part of the baseline alone, not touching it at all, but trying to do something with the enhanced premium tax credits, which only began most recently by President Biden under the COVID pandemic. That begs the question: Why were enhanced premium tax credits necessary? Premiums had gone up so much. The Affordable Care Act was supposed to lower the cost of healthcare. The cost of healthcare has exploded. The cost of health insurance has exploded. And, unfortunately, under the enhanced premium tax credit, it doesn't matter what the premium is; the Federal taxpayer throws billions more at it. And the insurance companies lost the incentive to negotiate down prices because, whatever the price was, the taxpayer would help pay for it. And we misaligned the incentives to where the insurance companies actually do better if healthcare costs are high. Now, by the way, I am not here to bash insurance companies. We need them. They are essential. But everybody is going to respond to incentives, and the incentive here is not the right incentive. So how can we do something different? Well, I would like to empower the patient instead of sending billions to the insurance company. And if we can put in programs that lower healthcare costs, we may still have premiums that are too high this year, because, by gosh, we only have 2 months until the next plan year starts; but we are going to be able to substitute out these enhanced premiums with something that doesn't go to the insurance company but goes to you the patient. And we are going to begin the process of aligning incentives for giving the patient the incentive to find the better deal, and that begins to lower costs. By the way, that means that we have to think differently. Now, let's try a new approach, as opposed to just sending paper money to paper over the high healthcare costs and the resultant high premiums. This is kind of my idea. Right now, we have the enhanced premium tax credit, which I have been speaking of. It goes to the insurance company. That should say 20 right there. It says 80. I am just going to mark that out right now. Right now--give me just a second. I am going to take this down. I am going to go just like this, and I am going to go 20. And I don't know if you can see this, but that 20 is the administrative cost and the profit that the insurance companies take out of every dollar you take them. My assistant is getting me a marker. I had a misprint last night, and I don't want to be misprinted right now. This should be 20. Of that $26 billion, we are going to send them next year, 20 percent of the $26 billion goes to profit, and it goes to administrative costs. Can we do it better? By golly, we can. Here we go. I am going to get this out of here. I am just bugged the heck out of this. This should say 20. Twenty percent of the $26 billion that we send them next year would go to profit and administrative overhead. What if we give the patient the power? What if we say it goes to an account that she controls, that she can spend on her physician, her dental care, her prescriptions, on her eyeglasses? She can spend it on orthodontia. She can spend it on more things than this, and, by the way, 100 percent of the $26 billion would go to the real care that that woman and her family needs. So we need to empower her, not give 20 percent of $26 billion to insurance companies. Nothing against insurance companies. God bless them. We need them. But if I have a choice of empowering you or empowering them--100 percent to you or 20 percent to them--my vote is with you. And I think we as a Congress, no matter what your political party, should all vote the same way. I want to emphasize something here, by the way: This is prefunded. People think about flexible spending accounts, and they think: Well, my gosh, this poor person--120 percent of Federal poverty, 150 percent of Federal poverty--has to put their own money into this. No. We take the dollars that are in the enhanced premium tax credit, and we put them there instead, and it is prefunded. So it is a little different than we normally think of flexible spending accounts, but, it still works. Now, on a couple of things I have heard from my Democratic colleagues, by the way, my Democratic colleagues are concerned that whatever we pass over here will not get a vote in the House of Representatives. I am pleased to say that, yesterday, President Trump tweeted in favor of this proposal. I am sure he would ask Mike Johnson to take it up. If Democrats want to vote on something that benefits the American people--and, by the way, here is the tweet. You can't read this. It is classic President Trump. He is talking about money-sucking insurance companies. And then in all caps he goes:

Mr. CASSIDY

Mr. CASSIDY. I think Senator Moreno and, frankly, Senator Schumer are reflecting the frustration the American people have. I want to give a speech which is substantially the same as what I gave last night, and I will give it again later today. It is like TV advertising. I need people to actually listen to what I am saying as opposed to immediately presuming they know what I am going to say, and we end up in the same daggum situation we have been in for 39 days. We need to open the government, so if we need to talk about healthcare to open the government, let's talk about healthcare. Again, I worked for 20 years in a public hospital for the uninsured and the poorly insured. I know the consequences of this inflation that we have been having when it comes to health insurance. I know the impact it is having upon people as to whether or not--``My gosh, can I even afford to keep it?'' So Congress, Senate, let's find a solution, but to find a solution, we have to put down the way we have always thought, the way that--``Oh my gosh, we are going to oppose it if the other side proposes it just because the other side proposes.'' We have to actually move beyond the entrenched way of thinking and be creative. May I point out an irony here? Senator Moreno talked about irony. Right now--right now--Republicans are trying to return to the original ACA model in which money went straight to the patient but not to the insurance company. At some point, it wasn't funded, so the first Trump administration allowed a workaround, and that workaround has led to these high premiums. Democrats are going to the mattress to defend a workaround from the first Trump administration that was trying to make up for a portion of the Affordable Care Act that could not be implemented. They should be saying: Let's go back to the model of how the Affordable Care Act was supposed to be implemented. Instead, they are defending Trump 1 policies. I don't even know if they know that. But it is their ``My gosh, I have to oppose just to oppose'' that is going to defeat us getting out of this lockdown. Let's just talk about the enhanced premium tax credit, again, a program that sends billions--this coming year, $26 billion will go to insurers if all we do is a straight-out reauthorization. But that actually doesn't make healthcare less affordable; in fact, even for health insurance, it can make the policies more expensive for many of those who are in the individual market. Let me make it clear now. Let me show this chart as to the impact this is having upon health insurers. This is major health insurance company stock performance after the passage of ObamaCare, from March 2010 to November 2025. For UnitedHealth Group, they are up almost 1,200 percent; for Cigna, 800 percent. And you can go down the line. I am not bashing insurance companies. We need them. But do we really need to send $26 billion more this year when we can send it straight to the patient? By the way, we are not talking about doing away with every part of the health insurance program--just that portion currently being funded by the enhanced premium tax credits. When Senator Moreno talks about these dollars going to insurance companies, we can see the impact of that on their stock price. They are doing great. Let's maybe do something different. Instead of worrying about the pocketbook of the insurance company, let's worry about the pocketbook of our fellow American who is paying these higher costs. Instead of paying an insurance company to manage the care, my proposal is to have a prefunded Federal flexible spending account. Before I go into that detail, let's talk about the problems with the enhanced premium tax credits. By the way, this is Bill Cassidy talking. This is not the chairman of the HELP Committee. This is not the Trump administration. This is not the leader of the Senate. This is my proposal, and I don't attribute it to anybody--although I will note the President apparently is in support of it. Right now, I am speaking to my colleagues, and I am speaking to Americans who might be watching. The problems under the enhanced premium tax credit--if your insurance premium goes up, Washington just pays more. There is absolutely no incentive for the insurers to hold down costs because the more it costs, the more they get. Think about that. The higher the healthcare costs, the more the insurance company gets. They are not evil, but I will say there is a clear motivation here. If you are a profit-making company and you can be insensitive to how much that cost is increasing, you are going to be insensitive. We need to have an incentive to bring the cost down, we need to have transparency as to what things actually cost, and we need to reward families who actually try to save. I liken this to, if you have a broken bone and you put a bandage on it, it doesn't heal the fracture; it just hides the broken bone. Let's fix the broken bone. We actually need to help the patient, the family, be incentivized to shop for that lower cost and incentivize the companies to lower the cost. The enhanced premium tax credit doesn't empower patients; it enriches insurance companies. I will note that since this ObamaCare passed, insurance companies have done very well, but the patient's healthcare has become more expensive, and it is now out of reach for many families. I got a tweet last night from one of my Democratic colleagues. ``No, we have to defend status quo.'' I am thinking--and this person is a vociferous critic of insurance companies--I am thinking: Will you just listen? As opposed to just reject, listen. We don't want this $26 billion going to insurance companies, where 20 percent of it is taken for administrative overhead and profit; we want it to go to the families, where 100 percent is paid for healthcare--and not in some way which puts them at a disadvantage but in a way that puts them at an advantage. As opposed to discussing this over Twitter, let's actually meet face to face and see if you can be persuaded that this is a better way to go. So what can we do to break the model and do something different? Imagine a different type of health--not an insurance subsidy but a health account that you, our fellow Americans, control. Right now, where does the healthcare dollar go? In the enhanced premium tax credit, it goes to the insurance company. Twenty percent is going to administrative overhead--that should read 80 percent--and 80 percent is going to pay for payment of care. So 20 percent for administrative overhead--you lose that--80 percent to take care of payments. Here, we take that portion of the current payment the Federal Government is making that goes to enhanced premium tax credits, and we put it in a prefunded, flexible savings account, and the patient has an account. My wife and I have one of these. It works pretty well. One hundred percent of the money goes to pay for healthcare. It can pay for the physician, the medicine. It can pay for dentistry and orthodontia-- all of that. So in all of this, you have a 20-percent plus-up in the amount available to actually pay for healthcare. Every eligible American citizen on the exchange would get this federally prefunded--I keep stressing the prefunded. In the health savings account my wife and I have--we are on an ObamaCare exchange--we actually take a portion of our income and we designate it to go into the flexible spending account. But here, we would take a value equal to the amount the person would have otherwise received from the enhanced premium tax credit, and we put it in the flexible spending account, and it pays for the real-world expenses I just mentioned. It pays for dental care. It pays for eyeglasses. Keep in mind, many insurance companies on the exchanges don't pay for dental care, and they don't pay for eyeglasses. It is something extra that you have to purchase. In this case, the flexible spending account would allow that to be done for prescription drugs, your routine medical services, and preventive care. It does not go for premiums, though. It goes to the patient. The patient then uses it as she understands it helps her family's budget the most. By the way, let me just give a shout-out to the President. He recognizes we have a problem. He knows the insurance market is broken. He put out a tweet last night favoring this approach. You can't read this because it is too much language, but you will see it is from Donald J. Trump, and the bottom line is he wants the money to go to the patients and not to insurance companies. The response to that from one of my Democratic colleagues was: Oh, oh, oh. We are taking money from insurance companies. No, we are taking that portion that would be part of the enhanced premium tax credit, and we are putting it in a prefunded flexible spending account. If people would just listen as opposed to automatically rejecting and if people would realize that Democrats are defending a Republican workaround to something that ObamaCare tried to do, but they wrote the language poorly so it couldn't be implemented, maybe they would stop and reconsider: Why am I part of this totally ironic situation, where Democrats are fighting to the death keeping the government closed for almost 40 days because we want to defend Trump 1 administration policies? The irony here is incredible. So the President is posting that we need to redirect these enhanced premium tax credit subsidy amounts to Americans so that they can get their own healthcare. I agree with the President. We need to give the money to the patients and bypass the insurance companies for this portion of what they would otherwise receive. I have also been told ``it sounds great, Bill, but it sounds complicated.'' There are 72 percent of Americans who are working for a government entity--the Federal Government, the State, and local--who have access to a flexible spending account, and 47 percent of those are in the commercial market. Hundreds of millions of Americans have access to these accounts. My wife and I have had an account for several years. This is not complicated. My wife and I are on the Small Business ObamaCare exchange. It is not offered on the individual exchange, but it is offered on the Small Business exchange. It is the one Congress is on. The point is that we are already doing this. You say it is complicated. Yet we are already doing it. So I am not quite sure where the complication comes in. It is like saying it is complicated to play a football game, but we have been playing football games every Friday, Saturday, and Sunday. No, it is not complicated. We know the rules of the game. The players know who they are. They go out and play, and we have a score. By the way, if there were going to be some bureaucratic obstacle to getting some rule changed in order to make sure we can take it from one exchange to the other, even the people who hate President Donald J. Trump will admit that guy can get the bureaucracy to do things. If there is anybody in Washington, DC, who can get something done when a bureaucrat says it can't be, it is Donald J. Trump. So you may not like the guy, but at this point, his strength is our strength, so let's use his strength to solve this problem if we can just get beyond an outright rejection because the President might like it too. I have one example, and I will hold that example just for the sake of time. Let me make clear the differences between the enhanced premium tax credits and a federally funded, prefunded flexible spending account. Again, this is only the portion benefiting the patient that currently goes to the enhanced premium tax credit, which will be $26 billion this coming year. Who gets the money from the enhanced premium tax credit? Insurance companies. Under a prefunded flexible savings account? Patients and families. What can it be used for? Insurance premiums. For patients? Real care--doctors' visits, dentists' visits, glasses, prescriptions--boom--real care. Who makes the decision, the insurance company? No. In the prefunded FSA, it is the patient making the decision. Does it lower costs? No. Demonstrably, this enhanced premium tax credit has contributed to higher premium costs. Here, the patient is empowered to shop. ``If I can get my medical service--my mammogram, my MRI--cheaper here than there, I am motivated to do that because it leaves more money in my pocket.'' That is called patient empowerment. Give the patient the power, dadgummit. By the way, if it turns out you can save money by paying cash instead of the negotiated rate from the insurance company, pay cash, as that begins to lower it. You would at least get the negotiated price, but now you also have the option of paying cash. Believe it or not, it is oftentimes cheaper to pay cash than to pay the negotiated price from the insurance company. So you save money, and the taxpayers prefunding your account also save money. That is the essence of giving a patient the power. She picks the best deal just like she would for groceries, for a car, or for a house. Now, how does this empower consumers? The prefunded flexible spending account doesn't treat someone as a dependent of the Federal Government like the enhanced premium tax credit does. It treats them like a capable consumer who knows what is best for their family: where to go for the dental work, where to go for their pharmacy, and how much to pay in a negotiated rate from the insurance company or, if you can find it, in a cheaper cash price. Instead of Washington paying the insurance company to manage your day- to-day care, you manage it; the patient manages it; the mama manages it with fairness, transparency, and flexibility. By the way, some say: Well, won't this cost more? It will cost about the same as the enhanced premium tax credit, which should be--and is-- something to appeal to my Democratic colleagues. By and large, we would take the same money going for the enhanced premium tax credit, and we would put it into these prefunded flexible savings accounts. That would cut out the fraud; you would save some money there and some little bit and little bit. In the second year, I think we would save money. I would like to do this for 2 years--but this is up for talking--because people are going to start purchasing more wisely, and other reforms will kick in. The point being, my Democratic colleagues, it will cost about the same as far as I am concerned. The difference is, instead of 20 percent going to an insurance company's profit and administrative overhead, 100 percent is going for real care. So this isn't just fiscally responsible; it is common sense. Now, as I conclude, let me once more point out the irony. The irony is, with the enhanced premium tax credits, you can draw a straight line back to the higher premium cost associated with the Trump 1 administration trying to find a workaround for a poorly drafted Affordable Care Act, and since then, premiums have gone up. What my Democratic colleagues are fighting for to the death is to continue a direct result of that Trump 1 policy. We could say there is some irony that Republicans are saying: Let's go back to an original structure because it gave more money to the patient. I would like to say that is something that, as a Republican, I was always for. But I would say that, currently, the Democratic position is entrenched--not all--but entrenched. If a Republican proposes it, if Donald Trump tweets in favor of it, we have to reject it. All I am asking is to stop being a Democrat for just a second and be an American. Be an American who hasn't been paid for 40 days. Be an American who is paying too much for her health insurance and too much for her healthcare. Stop being a partisan, and start being an American. I am ready to talk. Again, it is Bill Cassidy. It is not Trump. It is not Thune. It is not anybody else. But only when we begin to communicate are we going to find a solution that works for us all. Let's stop writing blank checks to insurance companies. Let's invest in the patients. I will finish by saying this: We have got to open the government. We have got to open the government. Now, once we do that, we will have the people back who can finish drafting this, but we have to be willing to take a risk. We have to get out of our entrenched positions. By the way, I am going to get criticized for this, but we have got to take a risk. If we take that risk--if we are brave enough to do something different--then we are going to solve this problem. I am a doctor, but most importantly, I am a doctor who is an American, who wants our country to be served by a Congress which is less concerned about partisan bickering than about the people back home. With that, I yield the floor.

Mr. CASSIDY. I will. Yes, sir.

Mr. CASSIDY. Unfortunately, none.

Mr. CASSIDY. Absolutely not.

Mr. CASSIDY. Absolutely not.

Mr. CASSIDY. It does nothing to benefit those people you are describing.