79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–853 

THE ‘‘RESPONSIBLE ADDITIONS AND INCREASES TO 

SUSTAIN EMPLOYEE HEALTH BENEFITS 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. 6313] 

The Committee on Ways and Means, to whom was referred the 

bill (H.R. 6313) to amend the Internal Revenue Code of 1986 to 

provide that a plan shall not fail to be treated as a health flexible 

spending account merely because such arrangement’s account balance (or any portion thereof) determined as of the end of any plan 

year may be carried forward to the succeeding plan year, report favorably thereon with an amendment and recommend that the bill 

as amended do pass. 

2 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–853 

RESPONSIBLE ADDITIONS AND INCREASES TO SUSTAIN 

EMPLOYEE HEALTH BENEFITS 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 

DISSENTING VIEWS 

[To accompany H.R. 6313] 

The Committee on Ways and Means, to whom was referred the 

bill (H.R. 6313) to amend the Internal Revenue Code of 1986 to 

allow the carryforward of health flexible spending arrangement account balances, 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 ...................................................................... 4 

A. Carryforward of Health Flexible Spending Arrangement Account 

Balances .............................................................................................. 4 

III. VOTES OF THE COMMITTEE ...................................................................... 7 

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 ...................................................................... 10 

C. Cost Estimate Prepared by the Congressional Budget Office ........... 10 

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

HOUSE .......................................................................................................... 10 

A. Committee Oversight Findings and Recommendations .................... 10 

B. Statement of General Performance Goals and Objectives ................ 10 

C. Information Relating to Unfunded Mandates .................................... 10 

D. Applicability of House Rule XXI 5(b) .................................................. 11 

E. Tax Complexity Analysis ..................................................................... 11 

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

Benefits ............................................................................................... 11 

3 

G. Duplication of Federal Programs ........................................................ 11 

H. Disclosure of Directed Rule Makings ................................................. 11 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED 12 

B. Changes in Existing Law Proposed by the Bill, as Reported ........... 12 

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 ‘‘Responsible Additions and Increases to Sustain Employee Health Benefits Act of 2018’’. 

SEC. 2. CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT ACCOUNT BALANCES. 

(a) IN GENERAL.—Section 106 of the Internal Revenue Code of 1986 is amended 

by adding at the end the following new subsection: 

‘‘(h) CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT ACCOUNT

BALANCES.—A plan shall not fail to be treated as a health flexible spending arrangement under this section or section 105 merely because such arrangement’s account 

balance (or any portion thereof) determined as of the end of any plan year may be 

carried forward to the succeeding plan year.’’. 

(b) COORDINATION WITH LIMITATION ON SALARY REDUCTION CONTRIBUTIONS.— 

(1) IN GENERAL.—Section 125(i) of such Code is amended by redesignating 

paragraph (2) as paragraph (3) and by inserting after paragraph (1) the following new paragraph: 

‘‘(2) COORDINATION WITH CARRYFORWARD OF ACCOUNT BALANCES.—The dollar 

amount otherwise in effect under paragraph (1) for any plan year shall be reduced by the excess (if any) of— 

‘‘(A) the amount of any account balance which is carried forward to such 

plan year from the preceding plan year, over 

‘‘(B) $500.’’. 

(2) CONFORMING AMENDMENTS.—Section 125(i) of such Code is amended by 

striking ‘‘taxable year’’ each place it appears in paragraphs (1) and (3) (as redesignated by paragraph (1) of this subsection) and inserting ‘‘plan year’’. 

(c) COORDINATION WITH CAFETERIA PLAN LIMITATION ON DEFERRED COMPENSATION.—Section 125(d)(2) of such Code is amended by adding at the end the following 

new subparagraph: 

‘‘(E) EXCEPTION FOR HEALTH FLEXIBLE SPENDING ARRANGEMENTS.—Subparagraph (A) shall not apply to a plan to the extent of amounts in a health 

flexible spending arrangement which may be carried forward as described 

in section 106(h).’’. 

(d) EFFECTIVE DATE.—The amendment made by this section shall apply to plan 

years beginning after December 31, 2018. 

I. SUMMARY AND BACKGROUND 

A. PURPOSE AND SUMMARY

The bill H.R. 6313, as reported by the Committee on Ways and 

Means, allows balances in Flexible Spending Arrangements (FSA) 

to be carried forward each year. 

B. BACKGROUND AND NEED FOR LEGISLATION

FSAs are employer-established accounts to reimburse employees 

for qualified medical expenses. They are usually funded through 

voluntary salary reduction agreements with the employer, but employers can also contribute. Contributions are not subject to payroll 

or federal income taxes. Contributions to FSAs are capped at 

$2,650 in 2018. FSAs are ‘‘use-it-or-lose-it’’ arrangements, with the 

exception that employers may allow up to $500 to be carried over 

to the next year or allow a grace-period to use leftover funds during 

the first quarter of the next year. 

4 

1Sec. 106. 

2Sec. 105(b). 

According to the Employee Benefits Survey conducted by the Department of Labor, 44 percent of all civilian workers had access to 

a health FSA offered under a cafeteria plan in 2017. 

The use-it-or-lose-it nature of FSAs can lead to unnecessary 

health care expenditures at the end of the year or underfunding of 

such accounts. If consumers are able to roll-over their unused 

funds, they are more likely to become more economically efficient 

as this incentivizes consumers to only purchase what is needed. 

Additionally, the reduced spending of excess funds could have a 

positive effect on overall spending, including keeping premiums low 

through utilizing less services through the plan. 

C. LEGISLATIVE HISTORY

Background 

H.R. 6313 was introduced on July 6, 2018, and was referred to 

the Committee on Ways and Means. 

Committee action 

The Committee on Ways and Means marked up H.R. 6313, the 

‘‘Responsible Additions and Increases to Sustain Employee Health 

Benefits Act of 2018,’’ on July 12, 2018, and ordered the bill, as 

amended, favorably reported (with a quorum being present). 

Committee hearings 

The policy issues associated with Flexible Spending Accounts 

(FSAs) and need for legislative response were discussed at the following 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. CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT

ACCOUNT BALANCES

PRESENT LAW

Exclusion from income for employer-provided health coverage 

Employees are not taxed on (i.e., may exclude from gross income) 

the value of employer-provided health coverage under an accident 

or health plan.1 In addition, any reimbursements under an employer-provided accident or health plan for medical care expenses 

for employees, their spouses, their dependents, and adult children 

under age 27 generally are excluded from gross income.2 The excluVerDate Sep 11 2014 07:41 Jul 20, 2018 Jkt 079006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR853.XXX HR853
5 

3Secs. 3121(a)(2), 3231(e)(1), and 3306(a)(2). 

4Treas. Reg. sec. 1.105–2. 

5Sec. 106. 

6Sec. 125(a). To be excludable, however, any qualified benefit elected under a cafeteria plan 

must independently satisfy any requirements under the Code section that provides the exclusion, such as section 105(b) or 106. 

sion applies both to health coverage in the case in which an employer directly pays the cost of employees’ medical expenses not 

covered by insurance (i.e., a self-insured plan) and an employer 

purchased health insurance coverage for its employees. There generally is no limit on the amount of employer-provided health coverage that is excludable. A similar rule excludes employer-provided 

health insurance coverage from the employees’ wages for employment tax purposes.3

Employers may also provide health coverage in the form of an 

agreement to reimburse medical expenses of their employees, their 

spouses, their dependents, and adult children under age 27, not reimbursed by a health insurance plan, through arrangements which 

allow reimbursement for medical care not in excess of a specified 

dollar amount (either elected by an employee under a cafeteria 

plan or otherwise specified by the employer). An employer may 

agree to reimburse expenses for medical care of its employees (and 

their spouses and dependents), not covered by a health insurance 

plan, through a flexible spending arrangement (‘‘FSA’’) which allows reimbursement for medical expenses not in excess of a specified dollar amount. The amounts available for reimbursement must 

be exclusively for reimbursement for medical care.4

Reimbursements may be either elected by an employee under a 

cafeteria plan or otherwise specified by the employer under a 

health reimbursement arrangement (‘‘HRA’’). Reimbursements 

under these arrangements are excludable from gross income as reimbursements for medical care under employer-provided health 

coverage.5

Cafeteria plan 

General rules 

A cafeteria plan is a separate written plan of an employer under 

which all participants are employees, and participants are permitted to choose among at least one permitted taxable benefit (e.g., 

current cash compensation) and at least one qualified benefit (generally an employer-provided benefit excludable from gross income, 

such as employer-provided health coverage). If an employee receives a qualified benefit based on his or her election between the 

qualified benefit and a taxable benefit under a cafeteria plan, the 

qualified benefit generally is not includible in gross income.6 The 

amount of the cash compensation forgone pursuant to an election 

under a cafeteria plan is generally referred to as a salary reduction 

contribution. However, if a plan offering an employee an election 

between taxable benefits (including cash) and nontaxable qualified 

benefits does not meet the requirements for being a cafeteria plan, 

the election between taxable and nontaxable benefits generally results in gross income to the employee, regardless of what benefit 

6 

7Prop. Treas. Reg. sec. 1.125–1(b). 

8Sec. 125 and Prop. Treas. Reg. sec. 1.125–5. 

9 Rev. Proc. 2017–58, 2017–45 I.R.B. 489 (Nov. 6, 2017). 

10See sec. 125(d)(2). 11See, e.g., Notice 2005–42, 2005–23 I.R.B. 1204 (June 6, 2005). 12See Notice 2013–71, 2013–47, I.R.B. 532 (November 18, 2013). 

is elected and when the election is made.7 A cafeteria plan generally may not provide for deferral of compensation. 

Health flexible spending arrangement under a cafeteria plan 

A flexible spending arrangement for medical expenses under a 

cafeteria plan (commonly called a ‘‘health FSA’’) is health coverage 

in the form of an arrangement under which employees are given 

the option to reduce their current cash compensation and instead 

have the amount of the salary reduction contributions made available for use in reimbursing the employee for his or her medical expenses.8 For 2018, the maximum amount of salary reduction con- tributions for a year is limited to $2,650.9

Health FSAs are subject to the general requirements for cafeteria 

plans, including a requirement that such plans may not be plans 

of deferred compensation. This generally means that amounts remaining under a health FSA at the end of a plan year must be forfeited by the employee (referred to as the ‘‘use-it-or-lose-it’’ rule).10

However, guidance provides a grace period of two and one-half 

months after the end of the plan year for the carryover of excess 

benefits or contributions in a health FSA.11 As an alternative to a 

grace period, an employer may amend the cafeteria plan document 

to provide for $500 of any unused amounts in a health FSA to be 

continuously rolled over.12 If an employee leaves employment during a year and has a balance in a health FSA (but no eligible unreimbursed medical expenses), that amount will be forfeited. 

REASONS FOR CHANGE

The Committee believes that health FSAs are an important tool 

in managing health care costs because amounts contributed to a 

health FSA are available in their entirety on the first day of the 

plan year, rather than needing to be accumulated in a fund before 

becoming available to pay for medical care costs. However, health 

FSAs are constrained by the use-it-or-lose-it rule because, at the 

end of a year, if an individual has a balance in his or her health 

FSA that he or she believes may be lost, the individual is more 

likely to spend those amounts on medical care that they might not 

otherwise have chosen to do (or need to do) leading to inefficient 

consumer health spending. 

The Committee believes that if an individual is permitted to 

carry forward those amounts to future years, they will more likely 

purchase medical care only when there is a need for such care, 

leading to better containment of health costs. 

EXPLANATION OF PROVISION

Under the provision, a plan shall not fail to be treated as a 

health flexible spending arrangement merely because such arrangement’s account balance (or any portion thereof) determined as 

of the end of any plan year may be carried forward to the succeeding plan year. The dollar amount that may be contributed to 

7 

an FSA in any plan year in which the amount of any balance (or 

any portion of the balance) from the preceding plan year is carried 

forward to such plan year will be reduced by the excess, if any, of 

the amount of the account balance that is carried forward to such 

plan year from the preceding plan year over $500. To the extent 

that amounts in a health flexible spending arrangement may be 

carried forward as of the end of any plan year to the succeeding 

plan year, the carryover of such amounts will not cause the cafeteria plan to be treated as a plan which provides deferred compensation. 

EFFECTIVE DATE

The provision is effective for 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. 6313, the ‘‘Responsible Additions and Increases to 

Sustain Employee Health Benefits Act of 2018,’’ on July 12, 2018. 

H.R. 6313 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 22 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 ........................... X ........... ............. Mr. Kind ............................... X ........... .............

Mr. Paulsen ........................... X ........... ............. Mr. Pascrell .......................... ........... ........... .............

Mr. Marchant ........................ X ........... ............. Mr. Crowley .......................... ........... X .............

Ms. Black .............................. ........... ........... ............. Mr. Davis .............................. ........... X .............

Mr. Reed ............................... X ........... ............. Ms. Sanchez ......................... ........... X .............

Mr. Kelly ................................ X ........... ............. Mr. Higgins .......................... ........... X .............

Mr. Renacci ........................... ........... ........... ............. 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. 6313, as reported. 

8 

The bill, as reported, is estimated to have the following effect on 

Federal fiscal year budget receipts for the period 2019–2028: 

9 

Fiscal Years 

[Millions of Dollars] 

Item 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019–23 2019–28 

Permit Rollovers of Health Flexible Spending Arrangement 

Account Balances 1 ........................................................... ¥33 ¥51 ¥60 ¥64 ¥66 ¥67 ¥68 ¥74 ¥75 ¥75 ¥274 ¥634 

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 ........... ¥11 ¥17 ¥20 ¥21 ¥22 ¥22 ¥22 ¥23 ¥23 ¥23 ¥91 ¥204 

10 

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-reducing 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. 

11 

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. 

12 

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 III—ITEMS SPECIFICALLY EXCLUDED FROM 

GROSS INCOME 

* * * * * * * 

SEC. 106. CONTRIBUTIONS BY EMPLOYER TO ACCIDENT AND HEALTH 

PLANS. 

(a) GENERAL RULE.—Except as otherwise provided in this section, 

gross income of an employee does not include employer-provided 

coverage under an accident or health plan. 

(b) CONTRIBUTIONS TO ARCHER MSAS.— 

(1) IN GENERAL.—In the case of an employee who is an eligible individual, amounts contributed by such employee’s employer to any Archer MSA of such employee shall be treated 

as employer-provided coverage for medical expenses under an 

accident or health plan to the extent such amounts do not exceed the limitation under section 220(b)(1) (determined without 

regard to this subsection) which is applicable to such employee 

for such taxable year. 

13 

(2) NO CONSTRUCTIVE RECEIPT.—No amount shall be included 

in the gross income of any employee solely because the employee may choose between the contributions referred to in 

paragraph (1) and employer contributions to another health 

plan of the employer. 

(3) SPECIAL RULE FOR DEDUCTION OF EMPLOYER CONTRIBU- TIONS.—Any employer contribution to an Archer MSA, if otherwise allowable as a deduction under this chapter, shall be allowed only for the taxable year in which paid. 

(4) EMPLOYER MSA CONTRIBUTIONS REQUIRED TO BE SHOWN

ON RETURN.—Every individual required to file a return under 

section 6012 for the taxable year shall include on such return 

the aggregate amount contributed by employers to the Archer 

MSAs of such individual or such individual’s spouse for such 

taxable year. 

(5) MSA CONTRIBUTIONS NOT PART OF COBRA COVERAGE.— 

Paragraph (1) shall not apply for purposes of section 4980B. 

(6) DEFINITIONS.—For purposes of this subsection, the terms 

‘‘eligible individual’’ and ‘‘Archer MSA’’ have the respective 

meanings given to such terms by section 220. 

(7) CROSS REFERENCE.—For penalty on failure by employer 

to make comparable contributions to the Archer MSAs of comparable employees, see section 4980E. 

(c) INCLUSION OF LONG-TERM CARE BENEFITS PROVIDED THROUGH

FLEXIBLE SPENDING ARRANGEMENTS.— (1) IN GENERAL.—Gross income of an employee shall include 

employer-provided coverage for qualified long-term care services (as defined in section 7702B(c)) to the extent that such 

coverage is provided through a flexible spending or similar arrangement. 

(2) FLEXIBLE SPENDING ARRANGEMENT.—For purposes of this 

subsection, a flexible spending arrangement is a benefit program which provides employees with coverage under which— 

(A) specified incurred expenses may be reimbursed (subject to reimbursement maximums and other reasonable 

conditions), and 

(B) the maximum amount of reimbursement which is 

reasonably available to a participant for such coverage is 

less than 500 percent of the value of such coverage. 

In the case of an insured plan, the maximum amount reasonably available shall be determined on the basis of the underlying coverage. 

(d) CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.— 

(1) IN GENERAL.—In the case of an employee who is an eligible individual (as defined in section 223(c)(1)), amounts contributed by such employee’s employer to any health savings account (as defined in section 223(d)) of such employee shall be 

treated as employer-provided coverage for medical expenses 

under an accident or health plan to the extent such amounts 

do not exceed the limitation under section 223(b) (determined 

without regard to this subsection) which is applicable to such 

employee for such taxable year. 

(2) SPECIAL RULES.—Rules similar to the rules of paragraphs 

(2), (3), (4), and (5) of subsection (b) shall apply for purposes 

of this subsection. 

14 

(3) CROSS REFERENCE.—For penalty on failure by employer 

to make comparable contributions to the health savings accounts of comparable employees, see section 4980G. 

(e) FSA AND HRA TERMINATIONS TO FUND HSAS.— 

(1) IN GENERAL.—A plan shall not fail to be treated as a 

health flexible spending arrangement or health reimbursement 

arrangement under this section or section 105 merely because 

such plan provides for a qualified HSA distribution. 

(2) QUALIFIED HSA DISTRIBUTION.—The term ‘‘qualified HSA 

distribution’’ means a distribution from a health flexible spending arrangement or health reimbursement arrangement to the 

extent that such distribution— 

(A) does not exceed the lesser of the balance in such arrangement on September 21, 2006, or as of the date of 

such distribution, and 

(B) is contributed by the employer directly to the health 

savings account of the employee before January 1, 2012. 

Such term shall not include more than 1 distribution with respect to any arrangement. 

(3) ADDITIONAL TAX FOR FAILURE TO MAINTAIN HIGH DEDUCTIBLE HEALTH PLAN COVERAGE.— 

(A) IN GENERAL.—If, at any time during the testing period, the employee is not an eligible individual, then the 

amount of the qualified HSA distribution— 

(i) shall be includible in the gross income of the employee for the taxable year in which occurs the first 

month in the testing period for which such employee 

is not an eligible individual, and 

(ii) the tax imposed by this chapter for such taxable 

year on the employee shall be increased by 10 percent 

of the amount which is so includible. 

(B) EXCEPTION FOR DISABILITY OR DEATH.—Clauses (i) 

and (ii) of subparagraph (A) shall not apply if the employee ceases to be an eligible individual by reason of the 

death of the employee or the employee becoming disabled 

(within the meaning of section 72(m)(7)). 

(4) DEFINITIONS AND SPECIAL RULES.—For purposes of this 

subsection— 

(A) TESTING PERIOD.—The term ‘‘testing period’’ means 

the period beginning with the month in which the qualified HSA distribution is contributed to the health savings 

account and ending on the last day of the 12th month following such month. 

(B) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible individual’’ 

has the meaning given such term by section 223(c)(1). 

(C) TREATMENT AS ROLLOVER CONTRIBUTION.—A qualified HSA distribution shall be treated as a rollover contribution described in section 223(f)(5). 

(5) TAX TREATMENT RELATING TO DISTRIBUTIONS.—For purposes of this title— 

(A) IN GENERAL.—A qualified HSA distribution shall be 

treated as a payment described in subsection (d). 

(B) COMPARABILITY EXCISE TAX.— 

15 

(i) IN GENERAL.—Except as provided in clause (ii), 

section 4980G shall not apply to qualified HSA distributions. 

(ii) FAILURE TO OFFER TO ALL EMPLOYEES.—In the 

case of a qualified HSA distribution to any employee, 

the failure to offer such distribution to any eligible individual covered under a high deductible health plan 

of the employer shall (notwithstanding section 

4980G(d)) be treated for purposes of section 4980G as 

a failure to meet the requirements of section 4980G(b). 

(f) REIMBURSEMENTS FOR MEDICINE RESTRICTED TO PRESCRIBED

DRUGS AND INSULIN.—For purposes of this section and section 105, 

reimbursement for expenses incurred for a medicine or a drug shall 

be treated as a reimbursement for medical expenses 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. 

(g) QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENT.—For purposes of this section and section 105, payments or reimbursements from a qualified small employer health 

reimbursement arrangement (as defined in section 9831(d)) of an 

individual for medical care (as defined in section 213(d)) shall not 

be treated as paid or reimbursed under employer-provided coverage 

for medical expenses under an accident or health plan if for the 

month in which such medical care is provided the individual does 

not have minimum essential coverage (within the meaning of section 5000A(f)). 

(h) CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT ACCOUNT BALANCES.—A plan shall not fail to be treated as 

a health flexible spending arrangement under this section or section 

105 merely because such arrangement’s account balance (or any portion thereof) determined as of the end of any plan year may be carried forward to the succeeding plan year. 

* * * * * * * 

SEC. 125. CAFETERIA PLANS. 

(a) GENERAL RULE.—Except as provided in subsection (b), no 

amount shall be included in the gross income of a participant in 

a cafeteria plan solely because, under the plan, the participant may 

choose among the benefits of the plan. 

(b) EXCEPTION FOR HIGHLY COMPENSATED PARTICIPANTS AND KEY

EMPLOYEES.— 

(1) HIGHLY COMPENSATED PARTICIPANTS.—In the case of a 

highly compensated participant, subsection (a) shall not apply 

to any benefit attributable to a plan year for which the plan 

discriminates in favor of— 

(A) highly compensated individuals as to eligibility to 

participate, or 

(B) highly compensated participants as to contributions 

and benefits. 

(2) KEY EMPLOYEES.—In the case of a key employee (within 

the meaning of section 416(i)(1)), subsection (a) shall not apply 

to any benefit attributable to a plan for which the qualified 

benefits provided to key employees exceed 25 percent of the aggregate of such benefits provided for all employees under the 

16 

plan. For purposes of the preceding sentence, qualified benefits 

shall be determined without regard to the second sentence of 

subsection (f). 

(3) YEAR OF INCLUSION.—For purposes of determining the 

taxable year of inclusion, any benefit described in paragraph 

(1) or (2) shall be treated as received or accrued in the taxable 

year of the participant or key employee in which the plan year 

ends. 

(c) DISCRIMINATION AS TO BENEFITS OR CONTRIBUTIONS.—For purposes of subparagraph (B) of subsection (b)(1), a cafeteria plan does 

not discriminate where qualified benefits and total benefits (or employer contributions allocable to qualified benefits and employer 

contributions for total benefits) do not discriminate in favor of highly compensated participants. 

(d) CAFETERIA PLAN DEFINED.—For purposes of this section— 

(1) IN GENERAL.—The term ‘‘cafeteria plan’’ means a written 

plan under which— 

(A) all participants are employees, and 

(B) the participants may choose among 2 or more benefits consisting of cash and qualified benefits. 

(2) DEFERRED COMPENSATION PLANS EXCLUDED.— (A) IN GENERAL.—The term ‘‘cafeteria plan’’ does not include any plan which provides for deferred compensation. 

(B) EXCEPTION FOR CASH AND DEFERRED ARRANGE- MENTS.—Subparagraph (A) shall not apply to a profit-sharing or stock bonus plan or rural cooperative plan (within 

the meaning of section 401(k)(7)) which includes a qualified cash or deferred arrangement (as defined in section 

401(k)(2)) to the extent of amounts which a covered employee may elect to have the employer pay as contributions 

to a trust under such plan on behalf of the employee. 

(C) EXCEPTION FOR CERTAIN PLANS MAINTAINED BY EDUCATIONAL INSTITUTIONS.—Subparagraph (A) shall not 

apply to a plan maintained by an educational organization 

described in section 170(b)(1)(A)(ii) to the extent of 

amounts which a covered employee may elect to have the 

employer pay as contributions for post-retirement group 

life insurance if— 

(i) all contributions for such insurance must be 

made before retirement, and 

(ii) such life insurance does not have a cash surrender value at any time. 

For purposes of section 79, any life insurance described in 

the preceding sentence shall be treated as group-term life 

insurance. 

(D) EXCEPTION FOR HEALTH SAVINGS ACCOUNTS.—Subparagraph (A) shall not apply to a plan to the extent of 

amounts which a covered employee may elect to have the 

employer pay as contributions to a health savings account 

established on behalf of the employee. 

(E) EXCEPTION FOR HEALTH FLEXIBLE SPENDING AR- RANGEMENTS.—Subparagraph (A) shall not apply to a plan 

to the extent of amounts in a health flexible spending arrangement which may be carried forward as described in 

section 106(h). 

17 

(e) HIGHLY COMPENSATED PARTICIPANT AND INDIVIDUAL DEFINED.—For purposes of this section— 

(1) HIGHLY COMPENSATED PARTICIPANT.—The term ‘‘highly 

compensated participant’’ means a participant who is— 

(A) an officer, 

(B) a shareholder owning more than 5 percent of the voting power or value of all classes of stock of the employer, 

(C) highly compensated, or 

(D) a spouse or dependent (within the meaning of section 

152, determined without regard to subsections (b)(1), 

(b)(2), and (d)(1)(B) thereof) of an individual described in 

subparagraph (A), (B), or (C). 

(2) HIGHLY COMPENSATED INDIVIDUAL.—The term ‘‘highly 

compensated individual’’ means an individual who is described 

in subparagraph (A), (B), (C), or (D) of paragraph (1). 

(f) QUALIFIED BENEFITS DEFINED.—For purposes of this section— 

(1) IN GENERAL.—The term ‘‘qualified benefit’’ means any 

benefit which, with the application of subsection (a), is not includible in the gross income of the employee by reason of an 

express provision of this chapter (other than section 106(b), 

117, 127, or 132). Such term includes any group term life insurance which is includible in gross income only because it exceeds the dollar limitation of section 79 and such term includes 

any other benefit permitted under regulations. 

(2) LONG-TERM CARE INSURANCE NOT QUALIFIED.—The term 

‘‘qualified benefit’’ shall not include any product which is advertised, marketed, or offered as long-term care insurance. 

(3) CERTAIN EXCHANGE-PARTICIPATING QUALIFIED HEALTH

PLANS NOT QUALIFIED.— 

(A) IN GENERAL.—The term ‘‘qualified benefit’’ shall not 

include any qualified health plan (as defined in section 

1301(a) of the Patient Protection and Affordable Care Act) 

offered through an Exchange established under section 

1311 of such Act. 

(B) EXCEPTION FOR EXCHANGE-ELIGIBLE EMPLOYERS.— 

Subparagraph (A) shall not apply with respect to any employee if such employee’s employer is a qualified employer 

(as defined in section 1312(f)(2) of the Patient Protection 

and Affordable Care Act) offering the employee the opportunity to enroll through such an Exchange in a qualified 

health plan in a group market. 

(g) SPECIAL RULES.— 

(1) COLLECTIVELY BARGAINED PLAN NOT CONSIDERED DISCRIMINATORY.—For purposes of this section, a plan shall not be 

treated as discriminatory if the plan is maintained under an 

agreement which the Secretary finds to be a collective bargaining agreement between employee representatives and one 

or more employers. 

(2) HEALTH BENEFITS.—For purposes of subparagraph (B) of 

subsection (b)(1), a cafeteria plan which provides health benefits shall not be treated as discriminatory if— 

(A) contributions under the plan on behalf of each participant include an amount which— 

18 

(i) equals 100 percent of the cost of the health benefit coverage under the plan of the majority of the 

highly compensated participants similarly situated, or 

(ii) equals or exceeds 75 percent of the cost of the 

health benefit coverage of the participant (similarly 

situated) having the highest cost health benefit coverage under the plan, and 

(B) contributions or benefits under the plan in excess of 

those described in subparagraph (A) bear a uniform relationship to compensation. 

(3) CERTAIN PARTICIPATION ELIGIBILITY RULES NOT TREATED

AS DISCRIMINATORY.—For purposes of subparagraph (A) of subsection (b)(1), a classification shall not be treated as discriminatory if the plan— 

(A) benefits a group of employees described in section 

410(b)(2)(A)(i), and 

(B) meets the requirements of clauses (i) and (ii): 

(i) No employee is required to complete more than 3 

years of employment with the employer or employers 

maintaining the plan as a condition of participation in 

the plan, and the employment requirement for each 

employee is the same. 

(ii) Any employee who has satisfied the employment 

requirement of clause (i) and who is otherwise entitled 

to participate in the plan commences participation no 

later than the first day of the first plan year beginning 

after the date the employment requirement was satisfied unless the employee was separated from service 

before the first day of that plan year. 

(4) CERTAIN CONTROLLED GROUPS, ETC..—All employees who 

are treated as employed by a single employer under subsection 

(b), (c), or (m) of section 414 shall be treated as employed by 

a single employer for purposes of this section. 

(h) SPECIAL RULE FOR UNUSED BENEFITS IN HEALTH FLEXIBLE

SPENDING ARRANGEMENTS OF INDIVIDUALS CALLED TO ACTIVE

DUTY.— 

(1) IN GENERAL.—For purposes of this title, a plan or other 

arrangement shall not fail to be treated as a cafeteria plan or 

health flexible spending arrangement (and shall not fail to be 

treated as an accident or health plan) merely because such arrangement provides for qualified reservist distributions. 

(2) QUALIFIED RESERVIST DISTRIBUTION.—For purposes of this 

subsection, the term ‘‘qualified reservist distribution’’ means 

any distribution to an individual of all or a portion of the balance in the employee’s account under such arrangement if— 

(A) such individual was (by reason of being a member of 

a reserve component (as defined in section 101 of title 37, 

United States Code)) ordered or called to active duty for a 

period in excess of 179 days or for an indefinite period, and 

(B) such distribution is made during the period beginning on the date of such order or call and ending on the 

last date that reimbursements could otherwise be made 

under such arrangement for the plan year which includes 

the date of such order or call. 

(i) LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGEMENTS.— 

19 

(1) IN GENERAL.—For purposes of this section, if a benefit is 

provided under a cafeteria plan through employer contributions to a health flexible spending arrangement, such benefit 

shall not be treated as a qualified benefit unless the cafeteria 

plan provides that an employee may not elect for any øtaxable 

year¿ plan year to have salary reduction contributions in excess of $2,500 made to such arrangement. 

(2) COORDINATION WITH CARRYFORWARD OF ACCOUNT BALANCES.—The dollar amount otherwise in effect under paragraph (1) for any plan year shall be reduced by the excess (if 

any) of— 

(A) the amount of any account balance which is carried 

forward to such plan year from the preceding plan year, 

over 

(B) $500. 

ø(2)¿ (3) ADJUSTMENT FOR INFLATION.—In the case of any 

øtaxable year¿ plan year beginning after December 31, 2013, 

the dollar amount in paragraph (1) shall be increased by an 

amount equal to— 

(A) such amount, multiplied by 

(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which such øtaxable 

year¿ plan year begins by substituting ‘‘calendar year 

2012’’ for ‘‘calendar year 2016’’ in subparagraph (A)(ii) 

thereof. 

If any increase determined under this paragraph is not a multiple of $50, such increase shall be rounded to the next lowest 

multiple of $50. 

(j) SIMPLE CAFETERIA PLANS FOR SMALL BUSINESSES.— 

(1) IN GENERAL.—An eligible employer maintaining a simple 

cafeteria plan with respect to which the requirements of this 

subsection are met for any year shall be treated as meeting 

any applicable nondiscrimination requirement during such 

year. 

(2) SIMPLE CAFETERIA PLAN.—For purposes of this subsection, the term ‘‘simple cafeteria plan’’ means a cafeteria 

plan— 

(A) which is established and maintained by an eligible 

employer, and 

(B) with respect to which the contribution requirements 

of paragraph (3), and the eligibility and participation requirements of paragraph (4), are met. 

(3) CONTRIBUTION REQUIREMENTS.— 

(A) IN GENERAL.—The requirements of this paragraph 

are met if, under the plan the employer is required, without regard to whether a qualified employee makes any salary reduction contribution, to make a contribution to provide qualified benefits under the plan on behalf of each 

qualified employee in an amount equal to— 

(i) a uniform percentage (not less than 2 percent) of 

the employee’s compensation for the plan year, or 

(ii) an amount which is not less than the lesser of— 

(I) 6 percent of the employee’s compensation for 

the plan year, or 

20 

(II) twice the amount of the salary reduction 

contributions of each qualified employee. 

(B) MATCHING CONTRIBUTIONS ON BEHALF OF HIGHLY

COMPENSATED AND KEY EMPLOYEES.—The requirements of 

subparagraph (A)(ii) shall not be treated as met if, under 

the plan, the rate of contributions with respect to any salary reduction contribution of a highly compensated or key 

employee at any rate of contribution is greater than that 

with respect to an employee who is not a highly compensated or key employee. 

(C) ADDITIONAL CONTRIBUTIONS.—Subject to subparagraph (B), nothing in this paragraph shall be treated as 

prohibiting an employer from making contributions to provide qualified benefits under the plan in addition to contributions required under subparagraph (A). 

(D) DEFINITIONS.—For purposes of this paragraph— 

(i) SALARY REDUCTION CONTRIBUTION.—The term 

‘‘salary reduction contribution’’ means, with respect to 

a cafeteria plan, any amount which is contributed to 

the plan at the election of the employee and which is 

not includible in gross income by reason of this section. 

(ii) QUALIFIED EMPLOYEE.—The term ‘‘qualified employee’’ means, with respect to a cafeteria plan, any 

employee who is not a highly compensated or key employee and who is eligible to participate in the plan. 

(iii) HIGHLY COMPENSATED EMPLOYEE.—The term 

‘‘highly compensated employee’’ has the meaning given 

such term by section 414(q). 

(iv) KEY EMPLOYEE.—The term ‘‘key employee’’ has 

the meaning given such term by section 416(i). 

(4) MINIMUM ELIGIBILITY AND PARTICIPATION REQUIREMENTS.— 

(A) IN GENERAL.—The requirements of this paragraph 

shall be treated as met with respect to any year if, under 

the plan— 

(i) all employees who had at least 1,000 hours of 

service for the preceding plan year are eligible to participate, and 

(ii) each employee eligible to participate in the plan 

may, subject to terms and conditions applicable to all 

participants, elect any benefit available under the 

plan. 

(B) CERTAIN EMPLOYEES MAY BE EXCLUDED.—For purposes of subparagraph (A)(i), an employer may elect to exclude under the plan employees— 

(i) who have not attained the age of 21 before the 

close of a plan year, 

(ii) who have less than 1 year of service with the 

employer as of any day during the plan year, 

(iii) who are covered under an agreement which the 

Secretary of Labor finds to be a collective bargaining 

agreement if there is evidence that the benefits covered under the cafeteria plan were the subject of good 

21 

faith bargaining between employee representatives 

and the employer, or 

(iv) who are described in section 410(b)(3)(C) (relating to nonresident aliens working outside the United 

States). 

A plan may provide a shorter period of service or younger 

age for purposes of clause (i) or (ii). 

(5) ELIGIBLE EMPLOYER.—For purposes of this subsection— 

(A) IN GENERAL.—The term ‘‘eligible employer’’ means, 

with respect to any year, any employer if such employer 

employed an average of 100 or fewer employees on business days during either of the 2 preceding years. For purposes of this subparagraph, a year may only be taken into 

account if the employer was in existence throughout the 

year. 

(B) EMPLOYERS NOT IN EXISTENCE DURING PRECEDING

YEAR.—If an employer was not in existence throughout the 

preceding year, the determination under subparagraph (A) 

shall be based on the average number of employees that 

it is reasonably expected such employer will employ on 

business days in the current year. 

(C) GROWING EMPLOYERS RETAIN TREATMENT AS SMALL

EMPLOYER.— 

(i) IN GENERAL.—If— 

(I) an employer was an eligible employer for any 

year (a ‘‘qualified year’’), and 

(II) such employer establishes a simple cafeteria 

plan for its employees for such year, 

then, notwithstanding the fact the employer fails to 

meet the requirements of subparagraph (A) for any 

subsequent year, such employer shall be treated as an 

eligible employer for such subsequent year with respect to employees (whether or not employees during 

a qualified year) of any trade or business which was 

covered by the plan during any qualified year. 

(ii) EXCEPTION.—This subparagraph shall cease to 

apply if the employer employs an average of 200 or 

more employees on business days during any year preceding any such subsequent year. 

(D) SPECIAL RULES.— 

(i) PREDECESSORS.—Any reference in this paragraph 

to an employer shall include a reference to any predecessor of such employer. 

(ii) AGGREGATION RULES.—All persons treated as a 

single employer under subsection (a) or (b) of section 

52, or subsection (n) or (o) of section 414, shall be 

treated as one person. 

(6) APPLICABLE NONDISCRIMINATION REQUIREMENT.—For purposes of this subsection, the term ‘‘applicable nondiscrimination requirement’’ means any requirement under subsection (b) 

of this section, section 79(d), section 105(h), or paragraph (2), 

(3), (4), or (8) of section 129(d). 

(7) COMPENSATION.—The term ‘‘compensation’’ has the meaning given such term by section 414(s). 

22 

(k) CROSS REFERENCE.—For reporting and recordkeeping requirements, see section 6039D. 

(l) REGULATIONS.—The Secretary shall prescribe such regulations 

as may be necessary to carry out the provisions of this section. 

* * * * * * * 

(23) 

DISSENTING VIEWS 

H.R. 6313 Responsible Additions and Increases to Sustain 

Employee Health Benefits Act of 2018 

H.R. 6313 (Stivers, R–OH) allows individuals to rollover Flexible 

Spending Account (FSA) contributions. 

H.R. 6313 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 the 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 tax-preferred accounts, 

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 pre-existing conditions, help lower premiums for Americans, 

and improve affordability of health coverage. 

The Joint Committee on Taxation (JCT) estimates the cost of this 

bill to be $634 million over 10 years. Altogether the 11 bills the 

Committee marked up would add another $92 billion in unoffset 

tax cuts to the deficit. With these bills, 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. 

Æ