Sen. Bill Cassidy says talks have advanced to address out-of-pocket costs as ACA subsidies near expiration

Sen. Bill Cassidy, R-La., said in an interview that Republican and Democratic negotiators appear closer to an agreement to reduce out-of-pocket costs for people who buy coverage on Affordable Care Act exchanges, as enhanced premium subsidies are set to expire in the coming weeks. Cassidy serves as chair of the Senate Committee on Health, Education, Labor, and Pensions.

Cassidy said Republicans want to “put money in their pocket to pay the out of pocket,” and that while Democrats are pressing to address rising premiums, out-of-pocket exposure — deductibles and pre-authorization denials — is the immediate barrier to care for many enrollees. “I would say that we're closer,” he said, adding that agreement requires bipartisan cooperation in a Senate where 60 votes are typically necessary to pass major changes.

The focus on deductibles, Cassidy said, reflects clinical experience. “By the way, Anna, I'll just tell you as a doctor, I'll have a patient come and say, ‘I cannot afford this because I'm in my deductible,’” he said, arguing that addressing out-of-pocket costs could both improve access to needed care and reduce the risk of a government shutdown tied to unresolved enhanced premium tax credits.

Cassidy also highlighted proposals aimed at improving price transparency. He cited legislation introduced by Sen. Roger Marshall, dubbed the Price Tag Act, as an effort to let patients know upfront what services will cost so they can choose lower-cost providers. “How do you let people know upfront what it's going to cost them?” Cassidy asked, saying that if patients see an X-ray costs $50 at one place and $500 at another, they will seek the more affordable option.

On pharmacy pricing and health savings accounts, Cassidy criticized current practices that he said can “drain” HSAs because patients are charged list prices for drugs. He blamed pharmacy benefit managers and insurers for holding too much pricing power and said legislation should prevent list-price charges that exhaust patients' savings.

Cassidy further urged anti-fraud measures in any package. He said it is “estimated that billions of dollars on the Obamacare exchanges as they currently exist are going out for fraudulent payments,” citing cases in which policies are assigned so brokers can collect fees. He called for targeted anti-fraud provisions while adding that not all brokers are bad actors.

Cassidy also said Republicans plan to press reforms that would prevent taxpayers from funding coverage for people in the country illegally, and to tighten controls on improper payments. He acknowledged the practical constraint in the Senate, noting that any successful bill will require cross-party cooperation to reach the 60-vote threshold.

No formal legislation or votes were announced during the interview. Cassidy described proposals under discussion — including HSA-focused changes, price-transparency measures, and anti-fraud language — and said he hopes lawmakers will resolve open issues before the subsidy expiration to avoid disruptions for enrollees and a possible government shutdown.