119-hr1157

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1157 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 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

 February 10, 2025

 Mr. Steube (for himself and Mrs. Cammack) introduced the following 
 bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently 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 insurance Exchange.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Affordable Care and Comprehensive 
Economic Support through Savings Act'' or the ``ACCESS Act''.

SEC. 2. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN LIEU OF REDUCED COST-
 SHARING.

    (a) In General.--

Section 223 of the Internal Revenue Code of 1986 
is amended by adding at the end the following new subsection:
 ``
            (i) Health Savings Account Contributions in Lieu of Reduced Cost-
Sharing for Exchange-Provided Plans.--
 ``

    (1) In general.--In the case of any eligible insured who 
 is enrolled in an Exchange-provided high deductible health plan 
 for any month and who elects (at such time and in such manner 
 as the Secretary may provide) the application of this 
 subsection--
 ``
        (A) section 1402 of the Patient Protection and 
 Affordable Care Act shall not apply to such individual 
 for such month,
 ``
        (B) the health insurance issuer offering such 
 plan shall make a payment to a health savings account 
 of such individual for such month in an amount equal to 
 \1/12\ of the annual reduced cost-sharing actuarial 
 equivalent amount, and
 ``
            (C) the Secretary shall make payments to such 
 health insurance issuer in amounts which are equal to 
 the payments made by such issuer under subparagraph
        (B) .
 ``

    (2) Annual reduced cost-sharing actuarial equivalent 
 amount.--For purposes of this section, the term `annual reduced 
 cost-sharing actuarial equivalent amount' means, with respect 
 to any Exchange-provided high deductible health plan enrolled 
 in by an eligible insured, an amount that would produce an 
 actuarial value equal to the actuarial value of the reduction 
 in cost-sharing (as determined under 

section 1402 of the 
 Patient Protection and Affordable Care Act and without regard 
 to any election under this subsection) for the plan year 
 determined by taking into account the household income of the 
 eligible insured.
 ``

    (3) Restriction on distributions.--
 ``
        (A) In general.--Any trust which receives a 
 payment described in paragraph

    (1)
        (B) shall not be 
 treated as a health savings account for purposes of 
 this section unless the terms of such trust require 
 that, during any month during which such a payment is 
 received, no distribution may be made from such trust 
 unless such distribution is made to satisfy a charge 
 properly made to a qualified medical debit card.
 ``
        (B) Qualified medical debit card.--For purposes 
 of this paragraph, the term `qualified medical debit 
 card' means a debit card which--
 ``
            (i) is issued by a bank (as defined in 
 

section 408

    (n) ),
 ``
            (ii) is provided by the trustee of the 
 health savings account to the designated 
 beneficiary, and
 ``
            (iii) is encoded in such a manner that 
 the only expenses which may charged with such 
 card are amounts paid for medical care (as 
 defined in 

section 213
            (d) ).
 ``

    (4) Recapture of excess payments.--For purposes of 
 applying the recapture rules of 

section 36B

    (f)

    (2) --
 ``
        (A) payments made to the health savings account 
 of an individual under paragraph

    (1)
        (B) shall be 
 treated as an advance payment of the credit allowed 
 under 

section 36B, and
 ``
        (B) the credit allowed under 

section 36B shall be 
 treated as having been increased by the payments which 
 would have been made to the health savings account of 
 such individual under paragraph

    (1)
        (B) if such payments 
 had been determined using the household income of such 
 individual for the taxable year referred to in such 
 section.
 ``

    (5) Other definitions and special rules.--For purposes of 
 this section--
 ``
        (A) Exchange-provided high deductible health 
 plan.--The term `Exchange-provided high deductible 
 health plan' means, with respect to any eligible 
 insured, any high deductible health plan enrolled in by 
 such eligible insured through an Exchange established 
 under the Patient Protection and Affordable Care Act.
 ``
        (B) Eligible insured.--The term `eligible 
 insured' has the meaning given such term in 

section 1402

    (b) of the Patient Protection and Affordable Care 
 Act.
 ``
            (C) Coordination with contribution limits; etc.--
 The payments described in paragraph

    (1)
        (B) shall not 
 fail to be taken into account under this section as 
 contributions to the health savings account to which 
 paid and such payments shall not be required to be made 
 to the extent that the eligible insured does not have a 
 health savings account or such account is prohibited 
 from accepting such payment by reason of subsection
            (d) (1)
        (A)
            (ii) .''.

    (b) Requirements Related to Exchange-Provided High Deductible 
Health Plans.--

Section 1301

    (a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18021

    (a) ) is amended by adding at the end the 
following new paragraph:
 ``

    (5) Requirements related to high deductible health 
 plans.--
 ``
        (A) Requirement to offer high deductible health 
 plan as alternative.--A health plan in the silver level 
 of coverage in the individual market which is not a 
 high deductible health plan shall not be treated as a 
 qualified health plan unless the health insurance 
 issuer offering such plan offers a high deductible 
 health plan which is actuarially equivalent to such 
 plan to any individual who would be an eligible insured 
 (as defined in 

section 1402

    (b) ) if such individual were 
 enrolled in such plan.
 ``
        (B) Requirement to make health savings account 
 contributions upon election of eligible insured.--A 
 high deductible health plan shall not be treated as a 
 qualified health plan unless the health insurance 
 issuer offering such plan complies with the requirement 
 of 

section 223
            (i) (1)
        (B) of such Code with respect to 
 such plan.
 ``
            (C) Determination of actuarial value.--For 
 purposes of this Act, the actuarial value of a high 
 deductible health plan shall take into account payments 
 made by the issuer to a health savings account of the 
 enrollee pursuant to such plan.
 ``
            (D) High deductible health plan.--For purposes of 
 this paragraph, the term `high deductible health plan' 
 has the meaning given such term by 

section 223 of the 
 Internal Revenue Code of 1986.''.
            (c) Public Education.--Beginning on January 1, 2026, each health 
insurance issuer offering coverage through an Exchange established 
under the Patient Protection and Affordable Care Act, and each such 
Exchange, shall provide all prospective enrollees--

    (1) information regarding the availability of insurer-
 provided health savings account contributions in lieu of 
 reduced cost-sharing for silver level high deductible health 
 plans selected in the Exchange, and

    (2) information regarding how to establish and use a health 
 savings account.
            (d) Permanent Appropriation for Cost-Sharing Reduction Payments and 
HSA Contributions Made in Lieu of Such Payments.--Necessary amounts are 
appropriated to the Secretary of the Treasury for making payments 
described in 

section 1402
            (d) (3) of the Patient Protection and 
Affordable Care Act, and payments described in 

section 223
            (i) (1)
            (C) of 
the Internal Revenue Code of 1986 (as added by this section), for 
months beginning after December 31, 2025.

    (e) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2025.
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