```

[House Report 115-845]
[From the U.S. Government Publishing Office]

115th Congress    }                                 {         Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                 {         115-845

======================================================================

  THE ``PROMOTING HIGH-VALUE HEALTH CARE THROUGH FLEXIBILITY FOR HIGH 
                 DEDUCTIBLE HEALTH PLANS ACT OF 2018''

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6301]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6301) to amend the Internal Revenue Code of 1986 to 
provides that a high deductible health plan may permit certain 
coverage up to a dollar limit without satisfaction of the 
minimum deductible, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

115th Congress    }                                 {          Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                 {          115-845

======================================================================

 
     PROMOTING HIGH-VALUE HEALTH CARE THROUGH FLEXIBILITY FOR HIGH 
                  DEDUCTIBLE HEALTH PLANS ACT OF 2018

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 6301]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6301) to amend the Internal Revenue Code of 1986 to 
provide high deductible health plans with first dollar coverage 
flexibility, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
 I. SUMMARY AND BACKGROUND............................................3
II. EXPLANATION OF THE BILL...........................................5
        A. First Dollar Coverage Flexibility for High Deductible 
            Health Plans.........................................     5
III.VOTES OF THE COMMITTEE............................................6

IV. BUDGET EFFECTS OF THE BILL........................................7
        A. Committee Estimate of Budgetary Effects...............     7
        B. Statement Regarding New Budget Authority and Tax 
            Expenditures Budget Authority........................     9
        C. Cost Estimate Prepared by the Congressional Budget 
            Office...............................................     9
 V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE........9
        A. Committee Oversight Findings and Recommendations......     9
        B. Statement of General Performance Goals and Objectives.     9
        C. Information Relating to Unfunded Mandates.............     9
        D. Applicability of House Rule XXI 5(b)..................    10
        E. Tax Complexity Analysis...............................    10
        F. Congressional Earmarks, Limited Tax Benefits, and 
            Limited Tariff Benefits..............................    10
        G. Duplication of Federal Programs.......................    10
        H. Disclosure of Directed Rule Makings...................    10
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED............11
        B. Changes in Existing Law Proposed by the Bill, as 
            Reported.............................................    11

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Promoting High-Value Health Care 
Through Flexibility for High Deductible Health Plans Act of 2018''.

SEC. 2. FIRST DOLLAR COVERAGE FLEXIBILITY FOR HIGH DEDUCTIBLE HEALTH 
                    PLANS.

  (a) In General.--Section 223(c)(2) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new subparagraph:
                  ``(E) First dollar coverage flexibility.--
                          ``(i) In general.--A plan shall not fail to 
                        be treated as a high deductible health plan by 
                        reason of failing to have a deductible for not 
                        more than $250 of specified services for self-
                        only coverage (twice such amount in the case of 
                        family coverage) during a plan year.
                          ``(ii) Specified services.--For purposes of 
                        this subparagraph, the term `specified 
                        services' means, with respect to a plan, 
                        services other than preventive care (within the 
                        meaning of subparagraph (C)) identified under 
                        the terms of the plan as being services to 
                        which clause (i) applies.''.
  (b) Inflation Adjustment.--Section 223(g)(1) of such Code is 
amended--
          (1) by striking ``and (c)(2)(A)'' each place it appears and 
        inserting ``, (c)(2)(A), and (c)(2)(E)'', and
          (2) in subparagraph (B)--
                  (A) by striking ``such taxable year'' in the matter 
                preceding clause (i) and inserting ``the taxable year 
                (plan year in the case of the dollar amount in 
                subsection (c)(2)(E))'', and
                  (B) by striking ``clause (ii)'' and inserting 
                ``clauses (ii) and (iii)'' in clause (i), by striking 
                ``and'' at the end of clause (i), by striking the 
                period at the end of clause (ii) and inserting ``, 
                and'', and by inserting after clause (ii) the following 
                new clause:
                          ``(iii) in the case of the dollar amount in 
                        subsection (c)(2)(E) for plan years beginning 
                        in calendar years after 2019, `calendar year 
                        2018'.''.
  (c) Effective Date.--The amendments made by this section shall apply 
with respect to plan years beginning after December 31, 2018.

                       I. SUMMARY AND BACKGROUND

                         A. Purpose and Summary

    The bill H.R. 6301, as reported by the Committee on Ways 
and Means, expands access and enhances the utility of health 
savings accounts (HSAs) by offering health plans a certain 
amount of flexibility in their plan design while still 
maintaining eligibility for HSA contributions. This flexibility 
will allow insurers to offer coverage for high-value, low-cost 
services like telehealth, chronic disease management (e.g. 
diabetic testing strips), or primary care visits below the 
deductible.

                 B. Background and Need for Legislation

    According to a survey of 52 health insurers conducted by 
America's Health Insurance Plans (AHIP), 21.8 million people 
were covered by a High Deductible Health Plan (HDHP) with an 
HSA as of January 2017. These plans and accounts are an 
increasingly popular option for workers, and enrollment growth 
shows no sign of slowing. A survey of employer-sponsored health 
benefits found that 17 percent of all employers offered a HDHP 
with an HSA in 2017 compared to 2 percent in 2005.
    HSA account holders are diverse. According to WageWorks, 
Inc., the administrator of benefits for more than 7 million 
people, the median household income for an HSA accountholder is 
$57,060.
    In addition, a JCT analysis found that of the tax returns 
that took an HSA deduction in 2015, 71 percent of the returns 
reported an income of $200,000 or less, and 28 percent reported 
an income of $75,000 or less. Account holders are also 
distributed across age groups, with nearly a third between the 
ages of 25-44 and another third of account holders between the 
ages 45-64.
    Most critically, research has consistently found that such 
coverage, which empowers individuals and families to be more 
engaged health care consumers, is capable of significantly 
reducing health care costs. As Congress considers how to 
modernize and expand access to this type of consumer directed 
health care coverage, it is essential that such reforms 
preserve the structural integrity to bend the cost curve and 
ensure lower premiums.
    H.R. 6301 allows plans to modernize the benefit in a way 
that promotes high-value care on the front end, without 
upending the underlying economic incentives. HDHPs will still 
empower individuals to shop around, unleashing the powers of 
choice and competition to lower costs and increase quality.

                         C. Legislative History

Background

    H.R. 6301 was introduced on June 29, 2018, and was referred 
to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 6301, 
``Promoting High-Value Health Care Through Flexibility for High 
Deductible Health Plans Act of 2018,'' on July 11, 2018, and 
ordered the bill, as amended, favorably reported (with a quorum 
being present).

Committee hearings

    The policy issues associated with Health Savings Accounts 
(HSAs) and need for legislative response were discussed at 
three Ways and Means hearings during the 114th and 115th 
Congress:
           Full Committee Hearing on the Tax Treatment 
        of Health Care (April 14, 2016)
           Subcommittee on Health Member Day Hearing on 
        Tax-Related Proposals to Improve Health Care (May 17, 
        2016)
           Subcommittee on Health Hearing on Rising 
        Health Insurance Premiums Under the Affordable Care Act 
        (July 12, 2016)
           Subcommittee on Health Hearing on Lowering 
        Costs and Expanding Access to Health Care through 
        Consumer-Directed Health Plans (June 6, 2018)

                      II. EXPLANATION OF THE BILL

 A. First Dollar Coverage Flexibility for High Deductible Health Plans

                              PRESENT LAW

Health savings accounts

    An individual may establish a health savings account 
(``HSA'') only if the individual is covered under a plan that 
meets the requirements for a high deductible health plan, as 
described below. In general, HSAs provide tax-favored treatment 
for current medical expenses as well as the ability to save on 
a tax-favored basis for future medical expenses. In general, an 
HSA is a tax-exempt trust or custodial account created 
exclusively to pay for the qualified medical expenses of the 
account holder and his or her spouse and dependents.
    Within limits,\1\ contributions to an HSA made by or on 
behalf of an eligible individual are deductible by the 
individual. Contributions to an HSA are excludible from income 
and employment taxes if made by the employer. Earnings in HSAs 
are not taxable. Distributions from an HSA for qualified 
medical expenses are not includible in gross income. 
Distributions from an HSA that are not used for qualified 
medical expenses are includible in gross income and are subject 
to an additional tax of 20 percent. The 20-percent additional 
tax does not apply if the distribution is made after death, 
disability, or the individual attains the age of Medicare 
eligibility (age 65).
---------------------------------------------------------------------------
    \1\For 2018, the basic limit on annual contributions that can be 
made to an HSA is $3,450 in the case of self-only coverage and $6,900 
in the case of family coverage. (The 2018 limitation for family 
coverage was revised by the IRS to permit taxpayers to disregard the 
$6,850 limitation under the modified inflation adjustment of Pub. L. 
No. 115-97. Rev. Rul. 2018-27, 2018-20 I.R.B. 591, May 14, 2018.) The 
basic annual contributions limits are increased by $1,000 for 
individuals who have attained age 55 by the end of the taxable year 
(referred to as ``catch-up'' contributions).
---------------------------------------------------------------------------

High deductible health plans

    A high deductible health plan is a health plan that has an 
annual deductible which is not less than $1,350 (for 2018) for 
self-only coverage and twice this amount for family coverage, 
and for which the sum of the annual deductible and other annual 
out-of-pocket expenses (other than premiums) for covered 
benefits does not exceed $6,650 (for 2018) for self-only 
coverage and twice this amount for family coverage.\2\ These 
dollar thresholds are subject to inflation adjustment, based on 
chained CPI.\3\
---------------------------------------------------------------------------
    \2\Sec. 223(c)(2).
    \3\Sec. 223(g).
---------------------------------------------------------------------------
    An individual who is covered under a high deductible health 
plan is eligible to establish an HSA, provided that while such 
individual is covered under the high deductible health plan, 
the individual is not covered under any health plan that (1) is 
not a high deductible health plan and (2) provides coverage for 
any benefit (subject to certain exceptions) covered under the 
high deductible health plan.\4\
---------------------------------------------------------------------------
    \4\Sec. 223(c)(1).
---------------------------------------------------------------------------
    Various types of coverage are disregarded for this purpose, 
including coverage of any benefit provided by permitted 
insurance, coverage (whether through insurance or otherwise) 
for accidents, disability, dental care, vision care, or long-
term care, as well as certain limited coverage through health 
flexible savings accounts.\5\ Permitted insurance means 
insurance under which substantially all of the coverage 
provided relates to liabilities incurred under workers' 
compensation laws, tort liabilities, liabilities relating to 
ownership or use of property, or such other similar liabilities 
as specified by the Secretary under regulations. Permitted 
insurance also means insurance for a specified disease or 
illness, and insurance paying a fixed amount per day (or other 
period) of hospitalization.\6\
---------------------------------------------------------------------------
    \5\Sec. 223(c)(1)(B).
    \6\Sec. 223(c)(3).
---------------------------------------------------------------------------
    Under a safe harbor, a high deductible health plan is 
permitted to provide coverage for preventive care (within the 
meaning of section 1861 of the Social Security Act, except as 
otherwise provided by the Secretary) before satisfaction of the 
minimum deductible.\7\ IRS guidance provides a safe harbor of 
the types of coverage that constitute preventive care for this 
purpose.\8\
---------------------------------------------------------------------------
    \7\Sec. 223(c)(2)(C).
    \8\Notice 2004-23, 2004-15 I.R.B. 725 (April 12, 2004). See also 
Notice 2004-50, 2004-33 IRB 1 (Aug. 9, 2004); Notice 2008-59, 2008-29 
I.R.B. 123 (July 21, 2008); Notice 2013-37, 2013-40 I.R.B. 293 (Sept. 
30, 2013).
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that the provision would add value 
to high deductible health plans by giving such plans the 
flexibility to provide benefits (beyond preventive care 
services) up to a specified dollar cap before satisfying the 
plan's deductible.

                        EXPLANATION OF PROVISION

    The provision provides that a high deductible health plan 
is permitted to provide certain coverage (``specified 
services'') up to a dollar threshold for each plan year without 
satisfaction of the plan's minimum deductible. Thus, under the 
provision, a health plan will not fail to be treated as a high 
deductible health plan merely by reason of failing to require a 
deductible for specified services up to a dollar threshold for 
each plan year. The dollar threshold is $250 for self-only 
coverage (twice this amount for family coverage) for a plan 
year, and is subject to inflation adjustment based on chained 
CPI. The coverage permitted for this purpose is for services 
other than preventive care (to which the statutory safe harbor 
applies), which are identified under the terms of the plan as 
being services to which this plan option applies. Thus, the 
provision expands the rules on benefits available without 
satisfaction of the plan's minimum deductible that do not 
impact the availability of HSAs to individuals covered under a 
high deductible health plan.

                             EFFECTIVE DATE

    The provision applies to plan years beginning after 
December 31, 2018.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6301, ``Promoting High-Value Health Care 
Through Flexibility for High Deductible Health Plans Act of 
2018,'' on July 11, 2018.
    H.R. 6301 was ordered favorably reported to the House of 
Representatives as amended by an amendment in the nature of a 
substitute offered by Chairman Brady by a roll call vote of 24 
yeas to 14 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady........................       X   .......  .........  Mr. Neal...........  .......       X   .........
Mr. Johnson......................       X   .......  .........  Mr. Levin..........  .......       X   .........
Mr. Nunes........................  .......  .......  .........  Mr. Lewis..........  .......       X   .........
Mr. Reichert.....................       X   .......  .........  Mr. Doggett........  .......       X   .........
Mr. Roskam.......................       X   .......  .........  Mr. Thompson.......       X   .......  .........
Mr. Buchanan.....................       X   .......  .........  Mr. Larson.........  .......       X   .........
Mr. Smith (NE)...................       X   .......  .........  Mr. Blumenauer.....  .......       X   .........
Ms. Jenkins......................  .......  .......  .........  Mr. Kind...........       X   .......  .........
Mr. Paulsen......................       X   .......  .........  Mr. Pascrell.......  .......       X   .........
Mr. Marchant.....................       X   .......  .........  Mr. Crowley........  .......       X   .........
Ms. Black........................       X   .......  .........  Mr. Davis..........  .......       X   .........
Mr. Reed.........................       X   .......  .........  Ms. Sanchez........  .......       X   .........
Mr. Kelly........................       X   .......  .........  Mr. Higgins........  .......       X   .........
Mr. Renacci......................       X   .......  .........  Ms. Sewell.........  .......       X   .........
Ms. Noem.........................       X   .......  .........  Ms. DelBene........  .......       X   .........
Mr. Holding......................       X   .......  .........  Ms. Chu............  .......       X   .........
Mr. Smith (MO)...................       X   .......  .........
Mr. Rice.........................       X   .......  .........
Mr. Schweikert...................       X   .......  .........
Ms. Walorski.....................       X   .......  .........
Mr. Curbelo......................       X   .......  .........
Mr. Bishop.......................       X   .......  .........
Mr. LaHood.......................       X   .......  .........
Mr. Wenstrup.....................       X   .......  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL

               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6301, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal fiscal year budget receipts for the period 
2019-2028:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               Fiscal Years [Millions of Dollars]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                            Item                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    12019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Permit First Dollar Coverage Flexibility for High Deductible       -126       -236       -300       -325       -362       -412       -448       -503       -539       -565     -1,350     -3,818
 Health Plans\1\............................................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details do not add to totals due to rounding.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Estimate includes the following off-budget effects.......        -27        -51        -64        -70        -78        -89        -97       -103       -108       -114       -290       -801
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: The gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that the revenue-increasing tax 
provision involves no new tax expenditure.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6138, as 
reported. As of the filing of this report, the Committee had 
not received an estimate prepared by the Congressional Budget 
Office (CBO).

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE

          A. Committee Oversight Findings and Recommendations

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated into 
the description portions of this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                D. Applicability of House Rule XXI 5(b)

    Rule XXI 5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    Section 4022(b) of the Internal Revenue Service 
Restructuring and Reform Act of 1998 (``IRS Reform Act'') 
requires the staff of the Joint Committee on Taxation (in 
consultation with the Internal Revenue Service and the Treasury 
Department) to provide a tax complexity analysis. The 
complexity analysis is required for all legislation reported by 
the Senate Committee on Finance, the House Committee on Ways 
and Means, or any committee of conference if the legislation 
includes a provision that directly or indirectly amends the 
Internal Revenue Code of 1986 and has widespread applicability 
to individuals or small businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code of 1986 and that have ``widespread applicability'' to 
individuals or small businesses, within the meaning of the 
rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(c)(5) of rule XIII of the Rules 
of the House of Representatives, the Committee states that no 
provision of the bill establishes or reauthorizes: (1) a 
program of the Federal Government known to be duplicative of 
another Federal program, (2) a program included in any report 
from the Government Accountability Office to Congress pursuant 
to section 21 of Public Law 111-139, or (3) a program related 
to a program identified in the most recent Catalog of Federal 
Domestic Assistance, published pursuant to section 6104 of 
title 31, United States Code.

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), 
the following statement is made concerning directed rule 
makings: The Committee advises that the bill requires no 
directed rule makings within the meaning of such section.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

      B. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986

           *       *       *       *       *       *       *
Subtitle A--Income Taxes

           *       *       *       *       *       *       *

CHAPTER 1--NORMAL TAXES AND SURTAXES

           *       *       *       *       *       *       *

Subchapter B--Computation of Taxable Income

           *       *       *       *       *       *       *

PART VII--ADDITIONAL ITEMIZED DEDUCTIONS FOR INDIVIDUALS

           *       *       *       *       *       *       *

SEC. 223. HEALTH SAVINGS ACCOUNTS.

  (a) Deduction allowed.--In the case of an individual who is 
an eligible individual for any month during the taxable year, 
there shall be allowed as a deduction for the taxable year an 
amount equal to the aggregate amount paid in cash during such 
taxable year by or on behalf of such individual to a health 
savings account of such individual.
  (b) Limitations.--
          (1) In general.--The amount allowable as a deduction 
        under subsection (a) to an individual for the taxable 
        year shall not exceed the sum of the monthly 
        limitations for months during such taxable year that 
        the individual is an eligible individual.
          (2) Monthly limitation.--The monthly limitation for 
        any month is \1/12\ of--
                  (A) in the case of an eligible individual who 
                has self- only coverage under a high deductible 
                health plan as of the first day of such month, 
                $2,250.
                  (B) in the case of an eligible individual who 
                has family coverage under a high deductible 
                health plan as of the first day of such month, 
                $4,500.
          (3) Additional contributions for individuals 55 or 
        older.--
                  (A) In general.--In the case of an individual 
                who has attained age 55 before the close of the 
                taxable year, the applicable limitation under 
                subparagraphs (A) and (B) of paragraph (2) 
                shall be increased by the additional 
                contribution amount.
                  (B) Additional contribution amount.--For 
                purposes of this section, the additional 
                contribution amount is the amount determined in 
                accordance with the following table:

 
------------------------------------------------------------------------
                                     The additional contribution amount
  For taxable years beginning in:                    is:
------------------------------------------------------------------------
2004                                $500
2005                                $600
2006                                $700
2007                                $800
2008                                $900
2009 and thereafter                 $1,000.
------------------------------------------------------------------------

          (4) Coordination with other contributions.--The 
        limitation which would (but for this paragraph) apply 
        under this subsection to an individual for any taxable 
        year shall be reduced (but not below zero) by the sum 
        of--
                  (A) the aggregate amount paid for such 
                taxable year to Archer MSAs of such individual,
                  (B) the aggregate amount contributed to 
                health savings accounts of such individual 
                which is excludable from the taxpayer's gross 
                income for such taxable year under section 
                106(d) (and such amount shall not be allowed as 
                a deduction under subsection (a)), and
                  (C) the aggregate amount contributed to 
                health savings accounts of such individual for 
                such taxable year under section 408(d)(9) (and 
                such amount shall not be allowed as a deduction 
                under subsection (a)).
        Subparagraph (A) shall not apply with respect to any 
        individual to whom paragraph (5) applies.
          (5) Special rule for married individuals.--In the 
        case of individuals who are married to each other, if 
        either spouse has family coverage--
                  (A) both spouses shall be treated as having 
                only such family coverage (and if such spouses 
                each have family coverage under different 
                plans, as having the family coverage with the 
                lowest annual deductible), and
                  (B) the limitation under paragraph (1) (after 
                the application of subparagraph (A) and without 
                regard to any additional contribution amount 
                under paragraph (3))--
                          (i) shall be reduced by the aggregate 
                        amount paid to Archer MSAs of such 
                        spouses for the taxable year, and
                          (ii) after such reduction, shall be 
                        divided equally between them unless 
                        they agree on a different division.
          (6) Denial of deduction to dependents.--No deduction 
        shall be allowed under this section to any individual 
        with respect to whom a deduction under section 151 is 
        allowable to another taxpayer for a taxable year 
        beginning in the calendar year in which such 
        individual's taxable year begins.
          (7) Medicare eligible individuals.--The limitation 
        under this subsection for any month with respect to an 
        individual shall be zero for the first month such 
        individual is entitled to benefits under title XVIII of 
        the Social Security Act and for each month thereafter.
          (8) Increase in limit for individuals becoming 
        eligible individuals after the beginning of the year.--
                  (A) In general.--For purposes of computing 
                the limitation under paragraph (1) for any 
                taxable year, an individual who is an eligible 
                individual during the last month of such 
                taxable year shall be treated--
                          (i) as having been an eligible 
                        individual during each of the months in 
                        such taxable year, and
                          (ii) as having been enrolled, during 
                        each of the months such individual is 
                        treated as an eligible individual 
                        solely by reason of clause (i), in the 
                        same high deductible health plan in 
                        which the individual was enrolled for 
                        the last month of such taxable year.
                  (B) Failure to maintain high deductible 
                health plan coverage.--
                          (i) In general.--If, at any time 
                        during the testing period, the 
                        individual is not an eligible 
                        individual, then--
                                  (I) gross income of the 
                                individual for the taxable year 
                                in which occurs the first month 
                                in the testing period for which 
                                such individual is not an 
                                eligible individual is 
                                increased by the aggregate 
                                amount of all contributions to 
                                the health savings account of 
                                the individual which could not 
                                have been made but for 
                                subparagraph (A), and
                                  (II) the tax imposed by this 
                                chapter for any taxable year on 
                                the individual shall be 
                                increased by 10 percent of the 
                                amount of such increase.
                          (ii) Exception for disability or 
                        death.--Subclauses (I) and (II) of 
                        clause (i) shall not apply if the 
                        individual ceased to be an eligible 
                        individual by reason of the death of 
                        the individual or the individual 
                        becoming disabled (within the meaning 
                        of section 72(m)(7)).
                          (iii) Testing period.--The term 
                        ``testing period'' means the period 
                        beginning with the last month of the 
                        taxable year referred to in 
                        subparagraph (A) and ending on the last 
                        day of the 12th month following such 
                        month.
  (c) Definitions and special rules.--For purposes of this 
section--
          (1) Eligible individual.--
                  (A) In general.--The term ``eligible 
                individual'' means, with respect to any month, 
                any individual if--
                          (i) such individual is covered under 
                        a high deductible health plan as of the 
                        1st day of such month, and
                          (ii) such individual is not, while 
                        covered under a high deductible health 
                        plan, covered under any health plan--
                                  (I) which is not a high 
                                deductible health plan, and
                                  (II) which provides coverage 
                                for any benefit which is 
                                covered under the high 
                                deductible health plan.
                  (B) Certain coverage disregarded.--
                Subparagraph (A)(ii) shall be applied without 
                regard to--
                          (i) coverage for any benefit provided 
                        by permitted insurance,
                          (ii) coverage (whether through 
                        insurance or otherwise) for accidents, 
                        disability, dental care, vision care, 
                        or long-term care, and
                          (iii) for taxable years beginning 
                        after December 31, 2006, coverage under 
                        a health flexible spending arrangement 
                        during any period immediately following 
                        the end of a plan year of such 
                        arrangement during which unused 
                        benefits or contributions remaining at 
                        the end of such plan year may be paid 
                        or reimbursed to plan participants for 
                        qualified benefit expenses incurred 
                        during such period if--
                                  (I) the balance in such 
                                arrangement at the end of such 
                                plan year is zero, or
                                  (II) the individual is making 
                                a qualified HSA distribution 
                                (as defined in section 106(e)) 
                                in an amount equal to the 
                                remaining balance in such 
                                arrangement as of the end of 
                                such plan year, in accordance 
                                with rules prescribed by the 
                                Secretary.
                  (C) Special rule for individuals eligible for 
                certain veterans benefits.--An individual shall 
                not fail to be treated as an eligible 
                individual for any period merely because the 
                individual receives hospital care or medical 
                services under any law administered by the 
                Secretary of Veterans Affairs for a service-
                connected disability (within the meaning of 
                section 101(16) of title 38, United States 
                Code).
          (2) High deductible health plan.--
                  (A) In general.--The term ``high deductible 
                health plan'' means a health plan--
                          (i) which has an annual deductible 
                        which is not less than--
                                  (I) $1,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage, and
                          (ii) the sum of the annual deductible 
                        and the other annual out-of-pocket 
                        expenses required to be paid under the 
                        plan (other than for premiums) for 
                        covered benefits does not exceed--
                                  (I) $5,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage.
                  (B) Exclusion of certain plans.--Such term 
                does not include a health plan if substantially 
                all of its coverage is coverage described in 
                paragraph (1)(B).
                  (C) Safe harbor for absence of preventive 
                care deductible.--A plan shall not fail to be 
                treated as a high deductible health plan by 
                reason of failing to have a deductible for 
                preventive care (within the meaning of section 
                1861 of the Social Security Act, except as 
                otherwise provided by the Secretary).
                  (D) Special rules for network plans.--In the 
                case of a plan using a network of providers--
                          (i) Annual out-of-pocket 
                        limitation.--Such plan shall not fail 
                        to be treated as a high deductible 
                        health plan by reason of having an out-
                        of-pocket limitation for services 
                        provided outside of such network which 
                        exceeds the applicable limitation under 
                        subparagraph (A)(ii).
                          (ii) Annual deductible.--Such plan's 
                        annual deductible for services provided 
                        outside of such network shall not be 
                        taken into account for purposes of 
                        subsection (b)(2).
                  (E) First dollar coverage flexibility.--
                          (i) In general.--A plan shall not 
                        fail to be treated as a high deductible 
                        health plan by reason of failing to 
                        have a deductible for not more than 
                        $250 of specified services for self-
                        only coverage (twice such amount in the 
                        case of family coverage) during a plan 
                        year.
                          (ii) Specified services.--For 
                        purposes of this subparagraph, the term 
                        ``specified services'' means, with 
                        respect to a plan, services other than 
                        preventive care (within the meaning of 
                        subparagraph (C)) identified under the 
                        terms of the plan as being services to 
                        which clause (i) applies.
          (3) Permitted insurance.--The term ``permitted 
        insurance'' means--
                  (A) insurance if substantially all of the 
                coverage provided under such insurance relates 
                to--
                          (i) liabilities incurred under 
                        workers' compensation laws,
                          (ii) tort liabilities,
                          (iii) liabilities relating to 
                        ownership or use of property, or
                          (iv) such other similar liabilities 
                        as the Secretary may specify by 
                        regulations,
                  (B) insurance for a specified disease or 
                illness, and
                  (C) insurance paying a fixed amount per day 
                (or other period) of hospitalization.
          (4) Family coverage.--The term ``family coverage'' 
        means any coverage other than self-only coverage.
          (5) Archer MSA.--The term ``Archer MSA'' has the 
        meaning given such term in section 220(d).
  (d) Health savings account.--For purposes of this section--
          (1) In general.--The term ``health savings account'' 
        means a trust created or organized in the United States 
        as a health savings account exclusively for the purpose 
        of paying the qualified medical expenses of the account 
        beneficiary, but only if the written governing 
        instrument creating the trust meets the following 
        requirements:
                  (A) Except in the case of a rollover 
                contribution described in subsection (f)(5) or 
                section 220(f)(5), no contribution will be 
                accepted--
                          (i) unless it is in cash, or
                          (ii) to the extent such contribution, 
                        when added to previous contributions to 
                        the trust for the calendar year, 
                        exceeds the sum of--
                                  (I) the dollar amount in 
                                effect under subsection 
                                (b)(2)(B), and
                                  (II) the dollar amount in 
                                effect under subsection 
                                (b)(3)(B).
                  (B) The trustee is a bank (as defined in 
                section 408(n)), an insurance company (as 
                defined in section 816), or another person who 
                demonstrates to the satisfaction of the 
                Secretary that the manner in which such person 
                will administer the trust will be consistent 
                with the requirements of this section.
                  (C) No part of the trust assets will be 
                invested in life insurance contracts.
                  (D) The assets of the trust will not be 
                commingled with other property except in a 
                common trust fund or common investment fund.
                  (E) The interest of an individual in the 
                balance in his account is nonforfeitable.
          (2) Qualified medical expenses.--
                  (A) In general.--The term ``qualified medical 
                expenses'' means, with respect to an account 
                beneficiary, amounts paid by such beneficiary 
                for medical care (as defined in section 213(d)) 
                for such individual, the spouse of such 
                individual, and any dependent (as defined in 
                section 152, determined without regard to 
                subsections (b)(1), (b)(2), and (d)(1)(B) 
                thereof) of such individual, but only to the 
                extent such amounts are not compensated for by 
                insurance or otherwise. Such term shall include 
                an amount paid for medicine or a drug only if 
                such medicine or drug is a prescribed drug 
                (determined without regard to whether such drug 
                is available without a prescription) or is 
                insulin.
                  (B) Health insurance may not be purchased 
                from account.--Subparagraph (A) shall not apply 
                to any payment for insurance.
                  (C) Exceptions.--Subparagraph (B) shall not 
                apply to any expense for coverage under--
                          (i) a health plan during any period 
                        of continuation coverage required under 
                        any Federal law,
                          (ii) a qualified long-term care 
                        insurance contract (as defined in 
                        section 7702B(b)),
                          (iii) a health plan during a period 
                        in which the individual is receiving 
                        unemployment compensation under any 
                        Federal or State law, or
                          (iv) in the case of an account 
                        beneficiary who has attained the age 
                        specified in section 1811 of the Social 
                        Security Act, any health insurance 
                        other than a medicare supplemental 
                        policy (as defined in section 1882 of 
                        the Social Security Act).
          (3) Account beneficiary.--The term ``account 
        beneficiary'' means the individual on whose behalf the 
        health savings account was established.
          (4) Certain rules to apply.--Rules similar to the 
        following rules shall apply for purposes of this 
        section:
                  (A) Section 219(d)(2) (relating to no 
                deduction for rollovers).
                  (B) Section 219(f)(3) (relating to time when 
                contributions deemed made).
                  (C) Except as provided in section 106(d), 
                section 219(f)(5) (relating to employer 
                payments).
                  (D) Section 408(g) (relating to community 
                property laws).
                  (E) Section 408(h) (relating to custodial 
                accounts).
  (e) Tax treatment of accounts.--
          (1) In general.--A health savings account is exempt 
        from taxation under this subtitle unless such account 
        has ceased to be a health savings account. 
        Notwithstanding the preceding sentence, any such 
        account is subject to the taxes imposed by section 511 
        (relating to imposition of tax on unrelated business 
        income of charitable, etc. organizations).
          (2) Account terminations.--Rules similar to the rules 
        of paragraphs (2) and (4) of section 408(e) shall apply 
        to health savings accounts, and any amount treated as 
        distributed under such rules shall be treated as not 
        used to pay qualified medical expenses.
  (f) Tax treatment of distributions.--
          (1) Amounts used for qualified medical expenses.--Any 
        amount paid or distributed out of a health savings 
        account which is used exclusively to pay qualified 
        medical expenses of any account beneficiary shall not 
        be includible in gross income.
          (2) Inclusion of amounts not used for qualified 
        medical expenses.--Any amount paid or distributed out 
        of a health savings account which is not used 
        exclusively to pay the qualified medical expenses of 
        the account beneficiary shall be included in the gross 
        income of such beneficiary.
          (3) Excess contributions returned before due date of 
        return.--
                  (A) In general.--If any excess contribution 
                is contributed for a taxable year to any health 
                savings account of an individual, paragraph (2) 
                shall not apply to distributions from the 
                health savings accounts of such individual (to 
                the extent such distributions do not exceed the 
                aggregate excess contributions to all such 
                accounts of such individual for such year) if--
                          (i) such distribution is received by 
                        the individual on or before the last 
                        day prescribed by law (including 
                        extensions of time) for filing such 
                        individual's return for such taxable 
                        year, and
                          (ii) such distribution is accompanied 
                        by the amount of net income 
                        attributable to such excess 
                        contribution.
                Any net income described in clause (ii) shall 
                be included in the gross income of the 
                individual for the taxable year in which it is 
                received.
                  (B) Excess contribution.--For purposes of 
                subparagraph (A), the term ``excess 
                contribution'' means any contribution (other 
                than a rollover contribution described in 
                paragraph (5) or section 220(f)(5)) which is 
                neither excludable from gross income under 
                section 106(d) nor deductible under this 
                section.
          (4) Additional tax on distributions not used for 
        qualified medical expenses.--
                  (A) In general.--The tax imposed by this 
                chapter on the account beneficiary for any 
                taxable year in which there is a payment or 
                distribution from a health savings account of 
                such beneficiary which is includible in gross 
                income under paragraph (2) shall be increased 
                by 20 percent of the amount which is so 
                includible.
                  (B) Exception for disability or death.--
                Subparagraph (A) shall not apply if the payment 
                or distribution is made after the account 
                beneficiary becomes disabled within the meaning 
                of section 72(m)(7) or dies.
                  (C) Exception for distributions after 
                medicare eligibility.--Subparagraph (A) shall 
                not apply to any payment or distribution after 
                the date on which the account beneficiary 
                attains the age specified in section 1811 of 
                the Social Security Act.
          (5) Rollover contribution.--An amount is described in 
        this paragraph as a rollover contribution if it meets 
        the requirements of subparagraphs (A) and (B).
                  (A) In general.--Paragraph (2) shall not 
                apply to any amount paid or distributed from a 
                health savings account to the account 
                beneficiary to the extent the amount received 
                is paid into a health savings account for the 
                benefit of such beneficiary not later than the 
                60th day after the day on which the beneficiary 
                receives the payment or distribution.
                  (B) Limitation.--This paragraph shall not 
                apply to any amount described in subparagraph 
                (A) received by an individual from a health 
                savings account if, at any time during the 1-
                year period ending on the day of such receipt, 
                such individual received any other amount 
                described in subparagraph (A) from a health 
                savings account which was not includible in the 
                individual's gross income because of the 
                application of this paragraph.
          (6) Coordination with medical expense deduction.--For 
        purposes of determining the amount of the deduction 
        under section 213, any payment or distribution out of a 
        health savings account for qualified medical expenses 
        shall not be treated as an expense paid for medical 
        care.
          (7) Transfer of account incident to divorce.--The 
        transfer of an individual's interest in a health 
        savings account to an individual's spouse or former 
        spouse under a divorce or separation instrument 
        described in clause (i) of section 121(d)(3)(C) shall 
        not be considered a taxable transfer made by such 
        individual notwithstanding any other provision of this 
        subtitle, and such interest shall, after such transfer, 
        be treated as a health savings account with respect to 
        which such spouse is the account beneficiary.
          (8) Treatment after death of account beneficiary.--
                  (A) Treatment if designated beneficiary is 
                spouse.--If the account beneficiary's surviving 
                spouse acquires such beneficiary's interest in 
                a health savings account by reason of being the 
                designated beneficiary of such account at the 
                death of the account beneficiary, such health 
                savings account shall be treated as if the 
                spouse were the account beneficiary.
                  (B) Other cases.--
                          (i) In general.--If, by reason of the 
                        death of the account beneficiary, any 
                        person acquires the account 
                        beneficiary's interest in a health 
                        savings account in a case to which 
                        subparagraph (A) does not apply--
                                  (I) such account shall cease 
                                to be a health savings account 
                                as of the date of death, and
                                  (II) an amount equal to the 
                                fair market value of the assets 
                                in such account on such date 
                                shall be includible if such 
                                person is not the estate of 
                                such beneficiary, in such 
                                person's gross income for the 
                                taxable year which includes 
                                such date, or if such person is 
                                the estate of such beneficiary, 
                                in such beneficiary's gross 
                                income for the last taxable 
                                year of such beneficiary.
                          (ii) Special rules.--
                                  (I) Reduction of inclusion 
                                for predeath expenses.--The 
                                amount includible in gross 
                                income under clause (i) by any 
                                person (other than the estate) 
                                shall be reduced by the amount 
                                of qualified medical expenses 
                                which were incurred by the 
                                decedent before the date of the 
                                decedent's death and paid by 
                                such person within 1 year after 
                                such date.
                                  (II) Deduction for estate 
                                taxes.--An appropriate 
                                deduction shall be allowed 
                                under section 691(c) to any 
                                person (other than the decedent 
                                or the decedent's spouse) with 
                                respect to amounts included in 
                                gross income under clause (i) 
                                by such person.
  (g) Cost-of-living adjustment.--
          (1) In general.--Each dollar amount in subsections 
        (b)(2) [and (c)(2)(A)], (c)(2)(A), and (c)(2)(E) shall 
        be increased by an amount equal to--
                  (A) such dollar amount, multiplied by
                  (B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in 
                which [such taxable year] the taxable year 
                (plan year in the case of the dollar amount in 
                subsection (c)(2)(E)) begins determined by 
                substituting for ``calendar year 2016'' in 
                subparagraph (A)(ii) thereof--
                          (i) except as provided in [clause 
                        (ii)] clauses (ii) and (iii), 
                        ``calendar year 1997'', [and]
                          (ii) in the case of each dollar 
                        amount in subsection (c)(2)(A), 
                        ``calendar year 2003''[.], and
                          (iii) in the case of the dollar 
                        amount in subsection (c)(2)(E) for plan 
                        years beginning in calendar years after 
                        2019, ``calendar year 2018''.
        In the case of adjustments made for any taxable year 
        beginning after 2007, section 1(f)(4) shall be applied 
        for purposes of this paragraph by substituting ``March 
        31'' for ``August 31'', and the Secretary shall publish 
        the adjusted amounts under subsections (b)(2) [and 
        (c)(2)(A)], (c)(2)(A), and (c)(2)(E) for taxable years 
        beginning in any calendar year no later than June 1 of 
        the preceding calendar year.
          (2) Rounding.--If any increase under paragraph (1) is 
        not a multiple of $50, such increase shall be rounded 
        to the nearest multiple of $50.
  (h) Reports.--The Secretary may require--
          (1) the trustee of a health savings account to make 
        such reports regarding such account to the Secretary 
        and to the account beneficiary with respect to 
        contributions, distributions, the return of excess 
        contributions, and such other matters as the Secretary 
        determines appropriate, and
          (2) any person who provides an individual with a high 
        deductible health plan to make such reports to the 
        Secretary and to the account beneficiary with respect 
        to such plan as the Secretary determines appropriate.
The reports required by this subsection shall be filed at such 
time and in such manner and furnished to such individuals at 
such time and in such manner as may be required by the 
Secretary.

           *       *       *       *       *       *       *

                             MINORITY VIEWS

H.R. 6301 Promoting High-Value Health Care Through Flexibility for High 
                  Deductible Health Plans Act of 2018

    H.R. 6301 (Roskam, R-IL and Thompson, D-CA) allows 
insurance plans to offer limited services up to $250 before the 
deductible with the goal of incentivizing high-value, low-cost 
services (e.g., follow-up care or generic pharmaceuticals).
    At the beginning of the mark up, Mr. Doggett (D-TX) offered 
a motion to postpone the markup in light of the fact that the 
legislation under consideration would put forward $92 billion 
of tax cuts, with no offsets identified. The Republicans 
defeated this motion on party lines 22-16.
    H.R. 6301 does not undo sabotage, premium hikes, and 
benefit cuts Republicans have caused over the past 18 months. 
This bill was one in a series of 11 bills this Committee marked 
up that Republicans claim will help lower health care costs for 
consumers. This legislation does not undo the disruption and 
sabotage the Republicans have continued to inflict on the 
American health care system. Instead of focusing on expansion 
of HSAs and HDHPs, Democrats encourage the Committee to 
redirect its attention to legislation that could actually 
ensure that uninsured, low-income, and vulnerable people have 
real access to care. For example H.R. 5155, sponsored by Reps. 
Pallone, Neal, and Scott, would protect people with preexisting 
conditions, lower premiums for Americans, and improve 
affordability of health coverage.
    Legislation busts the deficit to benefit the wealthy, 
again. Altogether, the 11 bills that were marked up would add 
another $92 billion in unoffset tax cuts to the deficit. 
Republicans' attempts to expand HSAs (and encourage more 
enrollment in plans with high deductibles, covering very few 
up-front health costs) represent a continuation of their 
platform of shifting families into health plans that provide 
fewer health benefits and higher out-of-pocket costs--while 
providing greater tax benefits for higher-income individuals 
and corporate-special interests. According to 2014 Treasury 
data, only five percent of families with adjusted gross income 
of under $100,000 held money in an HSA, and those users' 
average account balances were $1,700.
    High Deductible Health Plans (HDHPs) and Health Savings 
Accounts (HSAs) do not promote healthy behavior. It is widely 
acknowledged that HSAs and HDHPs lead consumers to delay care. 
They do not encourage individuals to make better health care 
decisions, as Republicans' ``skin in the game'' talking points 
assert. Decades of research shows that exposure to high out-of-
pocket costs leads consumers to delay or forgo both necessary 
and unnecessary care. Delaying care and increasing costs run 
counter to Democratic policy goals of better coordinated, high-
value affordable care for the American family. This legislation 
demonstrates why high-deductible health plans in their current 
format do not allow consumers to see value in their health 
insurance.
    According to the American Hospital Association, ``Hospitals 
and health systems report that increased enrollment in HDHPs 
over the past several years has reduced access to care and 
subjected patients to costs they cannot afford. In addition, 
patients enrolled in HDHPs appear to delay care until they have 
reached their deductible or are in an emergency situation, 
which could lead to poorer health outcomes.''
    HSAs mostly benefit high-income taxpayers while doing 
little to help moderate-income families or the uninsured. High-
income people can best afford to save for health care expenses 
and are, therefore, the most likely to contribute to HSAs. 
Higher income filers are much likelier to establish HSAs than 
lower income filers--70 percent of HSA contributions come from 
households with incomes over $100,000, according to the Joint 
Committee on Taxation (JCT)--and they are likelier to max out 
their contributions. Additionally, high-income people receive 
the biggest tax benefit for each dollar contributed to an HSA 
because the value of a tax deduction rises with an individual's 
tax bracket. More than 44 percent of Americans can't afford a 
$400 emergency visit. For these families, it is unlikely that 
they have excess income to devote to a tax-preferred account.
    JCT estimates the cost of this bill to be $3.8 billion over 
10 years. With this bill, Republicans are adding more tax cuts 
and increasing the deficit. Republicans are using the deficit, 
which they keep making larger with cuts for the wealthy, to 
justify the deep cuts they plan to make to Medicare and 
Medicaid. Republicans already are proposing to cut Medicare and 
Medicaid by nearly a trillion dollars to try to pay for the tax 
cuts they have already enacted. This bill will only increase 
Republicans' call for further cuts to these critical programs.
                                           Richard E. Neal,
                                                    Ranking Member.

                                  [all]
```