I
119THCONGRESS
1
STSESSION H. R. 1157
To allow individuals to elect to receive contributions to a health savings
account in lieu of reduced cost-sharing under health insurance obtained
through a health insurance Exchange.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY10, 2025
Mr. S
TEUBE(for himself and Mrs. CAMMACK) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the committee concerned
A BILL
To allow individuals to elect to receive contributions to a
health savings account in lieu of reduced cost-sharing
under health insurance obtained through a health insur-
ance Exchange.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Affordable Care and 4
Comprehensive Economic Support through Savings Act’’ 5
or the ‘‘ACCESS Act’’. 6
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SEC. 2. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN 1
LIEU OF REDUCED COST-SHARING. 2
(a) I
NGENERAL.—Section 223 of the Internal Rev-3
enue Code of 1986 is amended by adding at the end the 4
following new subsection: 5
‘‘(i) H
EALTHSAVINGSACCOUNTCONTRIBUTIONS IN 6
L
IEU OFREDUCEDCOST-SHARING FOREXCHANGE-PRO-7
VIDEDPLANS.— 8
‘‘(1) I
N GENERAL.—In the case of any eligible 9
insured who is enrolled in an Exchange-provided 10
high deductible health plan for any month and who 11
elects (at such time and in such manner as the Sec-12
retary may provide) the application of this sub-13
section— 14
‘‘(A) section 1402 of the Patient Protec-15
tion and Affordable Care Act shall not apply to 16
such individual for such month, 17
‘‘(B) the health insurance issuer offering 18
such plan shall make a payment to a health 19
savings account of such individual for such 20
month in an amount equal to
1
⁄12of the annual 21
reduced cost-sharing actuarial equivalent 22
amount, and 23
‘‘(C) the Secretary shall make payments to 24
such health insurance issuer in amounts which 25
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are equal to the payments made by such issuer 1
under subparagraph (B). 2
‘‘(2) A
NNUAL REDUCED COST -SHARING ACTU-3
ARIAL EQUIVALENT AMOUNT .—For purposes of this 4
section, the term ‘annual reduced cost-sharing actu-5
arial equivalent amount’ means, with respect to any 6
Exchange-provided high deductible health plan en-7
rolled in by an eligible insured, an amount that 8
would produce an actuarial value equal to the actu-9
arial value of the reduction in cost-sharing (as deter-10
mined under section 1402 of the Patient Protection 11
and Affordable Care Act and without regard to any 12
election under this subsection) for the plan year de-13
termined by taking into account the household in-14
come of the eligible insured. 15
‘‘(3) R
ESTRICTION ON DISTRIBUTIONS .— 16
‘‘(A) I
N GENERAL.—Any trust which re-17
ceives a payment described in paragraph (1)(B) 18
shall not be treated as a health savings account 19
for purposes of this section unless the terms of 20
such trust require that, during any month dur-21
ing which such a payment is received, no dis-22
tribution may be made from such trust unless 23
such distribution is made to satisfy a charge 24
properly made to a qualified medical debit card. 25
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‘‘(B) QUALIFIED MEDICAL DEBIT CARD .— 1
For purposes of this paragraph, the term 2
‘qualified medical debit card’ means a debit 3
card which— 4
‘‘(i) is issued by a bank (as defined in 5
section 408(n)), 6
‘‘(ii) is provided by the trustee of the 7
health savings account to the designated 8
beneficiary, and 9
‘‘(iii) is encoded in such a manner 10
that the only expenses which may charged 11
with such card are amounts paid for med-12
ical care (as defined in section 213(d)). 13
‘‘(4) R
ECAPTURE OF EXCESS PAYMENTS .—For 14
purposes of applying the recapture rules of section 15
36B(f)(2)— 16
‘‘(A) payments made to the health savings 17
account of an individual under paragraph 18
(1)(B) shall be treated as an advance payment 19
of the credit allowed under section 36B, and 20
‘‘(B) the credit allowed under section 36B 21
shall be treated as having been increased by the 22
payments which would have been made to the 23
health savings account of such individual under 24
paragraph (1)(B) if such payments had been 25
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determined using the household income of such 1
individual for the taxable year referred to in 2
such section. 3
‘‘(5) O
THER DEFINITIONS AND SPECIAL 4
RULES.—For purposes of this section— 5
‘‘(A) E
XCHANGE-PROVIDED HIGH DEDUCT -6
IBLE HEALTH PLAN.—The term ‘Exchange-pro-7
vided high deductible health plan’ means, with 8
respect to any eligible insured, any high deduct-9
ible health plan enrolled in by such eligible in-10
sured through an Exchange established under 11
the Patient Protection and Affordable Care Act. 12
‘‘(B) E
LIGIBLE INSURED.—The term ‘eli-13
gible insured’ has the meaning given such term 14
in section 1402(b) of the Patient Protection 15
and Affordable Care Act. 16
‘‘(C) C
OORDINATION WITH CONTRIBUTION 17
LIMITS; ETC.—The payments described in para-18
graph (1)(B) shall not fail to be taken into ac-19
count under this section as contributions to the 20
health savings account to which paid and such 21
payments shall not be required to be made to 22
the extent that the eligible insured does not 23
have a health savings account or such account 24
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is prohibited from accepting such payment by 1
reason of subsection (d)(1)(A)(ii).’’. 2
(b) R
EQUIREMENTS RELATED TOEXCHANGE-PRO-3
VIDEDHIGHDEDUCTIBLEHEALTHPLANS.—Section 4
1301(a) of the Patient Protection and Affordable Care Act 5
(42 U.S.C. 18021(a)) is amended by adding at the end 6
the following new paragraph: 7
‘‘(5) R
EQUIREMENTS RELATED TO HIGH DE -8
DUCTIBLE HEALTH PLANS .— 9
‘‘(A) R
EQUIREMENT TO OFFER HIGH DE -10
DUCTIBLE HEALTH PLAN AS ALTERNATIVE .—A 11
health plan in the silver level of coverage in the 12
individual market which is not a high deductible 13
health plan shall not be treated as a qualified 14
health plan unless the health insurance issuer 15
offering such plan offers a high deductible 16
health plan which is actuarially equivalent to 17
such plan to any individual who would be an eli-18
gible insured (as defined in section 1402(b)) if 19
such individual were enrolled in such plan. 20
‘‘(B) R
EQUIREMENT TO MAKE HEALTH 21
SAVINGS ACCOUNT CONTRIBUTIONS UPON ELEC -22
TION OF ELIGIBLE INSURED .—A high deduct-23
ible health plan shall not be treated as a quali-24
fied health plan unless the health insurance 25
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issuer offering such plan complies with the re-1
quirement of section 223(i)(1)(B) of such Code 2
with respect to such plan. 3
‘‘(C) D
ETERMINATION OF ACTUARIAL 4
VALUE.—For purposes of this Act, the actuarial 5
value of a high deductible health plan shall take 6
into account payments made by the issuer to a 7
health savings account of the enrollee pursuant 8
to such plan. 9
‘‘(D) H
IGH DEDUCTIBLE HEALTH PLAN .— 10
For purposes of this paragraph, the term ‘high 11
deductible health plan’ has the meaning given 12
such term by section 223 of the Internal Rev-13
enue Code of 1986.’’. 14
(c) P
UBLICEDUCATION.—Beginning on January 1, 15
2026, each health insurance issuer offering coverage 16
through an Exchange established under the Patient Pro-17
tection and Affordable Care Act, and each such Exchange, 18
shall provide all prospective enrollees— 19
(1) information regarding the availability of in-20
surer-provided health savings account contributions 21
in lieu of reduced cost-sharing for silver level high 22
deductible health plans selected in the Exchange, 23
and 24
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(2) information regarding how to establish and 1
use a health savings account. 2
(d) P
ERMANENTAPPROPRIATION FOR COST-SHAR-3
INGREDUCTIONPAYMENTS AND HSA CONTRIBUTIONS 4
M
ADE INLIEU OFSUCHPAYMENTS.—Necessary amounts 5
are appropriated to the Secretary of the Treasury for 6
making payments described in section 1402(d)(3) of the 7
Patient Protection and Affordable Care Act, and pay-8
ments described in section 223(i)(1)(C) of the Internal 9
Revenue Code of 1986 (as added by this section), for 10
months beginning after December 31, 2025. 11
(e) E
FFECTIVEDATE.—The amendments made by 12
this section shall apply to months beginning after Decem-13
ber 31, 2025. 14
Æ
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