Sen. Rick Scott introduced the More Affordable Care Act on Nov. 20, 2025, proposing to replace current Obamacare subsidies with HSA-style Trump Health Freedom Accounts. Under Scott's plan, families would receive direct federal payments they can use to purchase health insurance or pay medical expenses. Healthcare.gov and state exchanges would continue operating, and protections for pre-existing conditions would remain in place. Scott said the bill makes simple fixes to Obamacare that will make a world of difference by making Americans the consumer, not the government, while giving them options and transparency.

Enhanced ACA tax credits expire Dec. 31, 2025, affecting 22 million Americans. Without the enhanced subsidies, average premiums will more than double on Jan. 1, 2026, according to KFF, a health policy nonprofit. In 🌴Florida alone, 4.7 million people could see premiums increase 226 percent, or $1,005 per year, according to Kaiser Family Foundation analysis. The majority of ACA enrollees must sign up by Dec. 15 for 2026 coverage or risk being shut out of the market.

President Trump has weighed extending enhanced subsidies for two years but hasn't committed to a plan. Senate Majority Leader John Thune (R-SD) promised a vote on enhanced tax credits by mid-December but wouldn't guarantee Republican support. House Speaker Mike Johnson (R-LA) hasn't committed to a vote and called the enhanced tax credits a boondoggle. The Trump administration initially planned to announce a proposal Nov. 24 but backed off, highlighting how challenging the issue has become.

Scott's Trump Health Freedom Accounts work like Health Savings Accounts (HSAs). Families receive federal dollars they can use for insurance premiums, doctor visits, prescriptions, or other medical expenses. The accounts aim to put health care decisions in the hands of Americans rather than insurance companies or government bureaucrats. Scott argues this gives families more control and transparency about health care costs.

Critics warn Scott's plan could destabilize insurance markets by pulling healthy people out of traditional plans. Insurance companies price premiums based on pooling risk across healthy and sick enrollees. If healthy people take direct payments and skip comprehensive coverage, premiums could skyrocket for those who need insurance most. The individual mandate, which required everyone to have coverage, was eliminated in 2017, removing one tool to keep healthy people in the market.

For middle-class enrollees without enhanced tax credits, even high-deductible Bronze level plans could be out of reach in some markets, according to CNBC analysis. A 60-year-old making $60,000 per year could see premiums jump from around $500 per month to over $1,500 per month without enhanced subsidies. Scott's direct payment approach might not provide enough money for comprehensive coverage, leaving families with catastrophic-only plans or no insurance.

The proposal comes amid broader Republican efforts to replace rather than extend Obamacare subsidies. Multiple GOP senators have floated alternatives aimed at lowering health care costs through market competition rather than government subsidies to insurance companies. Democrats want to bolster the ACA by extending COVID-19 pandemic-era tax credits that have driven record enrollment. The philosophical divide centers on whether government should subsidize insurance companies or consumers directly.