I 

116TH CONGRESS 

1ST SESSION H. R. 4651 

To amend the Internal Revenue Code of 1986 to expand health savings 

accounts, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 11, 2019 

Mr. KING of Iowa introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL 

To amend the Internal Revenue Code of 1986 to expand 

health savings accounts, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘American Future 

5 Healthcare Act of 2019’’. 

6 SEC. 2. REFORM OF HEALTH SAVINGS ACCOUNTS. 

7 (a) REPEAL OF HIGH DEDUCTIBLE HEALTH PLAN

8 REQUIREMENT.—Section 223(a) of the Internal Revenue 

9 Code of 1986 is amended to read as follows: 


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1 ‘‘(a) DEDUCTION ALLOWED.—In the case of an indi2 vidual, there shall be allowed as a deduction for a taxable 

3 year an amount equal to the aggregate amount paid in 

4 cash during such taxable year by or on behalf of such indi5 vidual to a health savings account of such individual.’’. 

6 (b) INCREASE IN DEDUCTIBLE HSA CONTRIBUTION

7 LIMITATIONS.—Section 223(b)(1) of such Code is amend8 ed by striking ‘‘the sum of the monthly’’ and all that fol9 lows through ‘‘eligible individual’’ and inserting ‘‘$10,000 

10 ($20,000 in the case of a joint return)’’. 

11 (c) MEDICARE ELIGIBLE INDIVIDUALS ELIGIBLE TO

12 CONTRIBUTE TO HSA.—Section 223(b) of such Code is 

13 amended by striking paragraph (7). 

14 (d) PURCHASE OF HEALTH INSURANCE.—Section 

15 223(d)(2) of such Code is amended— 

16 (1) by striking subparagraphs (B) and (C), and 

17 (2) by striking ‘‘QUALIFIED MEDICAL EX18 PENSES.—’’ and all that follows through ‘‘The term’’ 

19 and inserting ‘‘QUALIFIED MEDICAL EXPENSES.— 

20 The term’’. 

21 (e) COST-OF-LIVING ADJUSTMENT FOR CATCHUP

22 CONTRIBUTIONS.—Section 223(f)(1) of such Code (as re23 designated by subsection (g)(3)) is amended by striking 

24 ‘‘Each dollar amount in subsections (b)(2) and (c)(2)(A)’’ 

25 and inserting ‘‘In the case of a taxable year beginning 


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1 after December 31, 2019, each dollar amount in para2 graphs (1) and (2) of subsection (b)’’. 

3 (f) COST-OF-LIVING ADJUSTMENT INDEXED TO CPI 

4 MEDICAL CARE COMPONENT.—Section 223(f) (as so re5 designated) is amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(3) CPI MEDICAL CARE COMPONENT.— 

8 ‘‘(A) IN GENERAL.—For purposes of para9 graph (1), the cost-of-living adjustment deter10 mined under section 1(f)(3) for the calendar 

11 year shall be determined by substituting ‘CPI 

12 medical care component’ for ‘CPI’. 

13 ‘‘(B) CPI MEDICAL CARE COMPONENT.— 

14 For purposes of subparagraph (A), the term 

15 ‘CPI medical care component’ means the med16 ical care component for the Consumer Price 

17 Index for All Urban Consumers published by 

18 the Department of Labor.’’. 

19 (g) CONFORMING AMENDMENTS.— 

20 (1) Section 223(b) of such Code is amended by 

21 striking paragraphs (2), (5), and (8) and by redesig22 nating paragraphs (3), (4), and (6) as paragraphs 

23 (2), (3), and (4), respectively. 


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1 (2) Section 223(b)(3) of such Code (as redesig2 nated by paragraph (1)) is amended by striking the 

3 last sentence. 

4 (3) Section 223 of such Code is amended by 

5 striking subsection (c) and redesignating subsections 

6 (d) through (h) as subsections (c) through (g), re7 spectively. 

8 (4) Section 223(c)(1)(A) of such Code (as re9 designated by paragraph (3)) is amended— 

10 (A) by striking ‘‘subsection (f)(5)’’ and in11 serting ‘‘subsection (e)(5)’’; and 

12 (B) in clause (ii) by striking ‘‘the sum of— 

13 ’’ and all that follows and inserting ‘‘the dollar 

14 amount in effect under subsection (b)(1).’’. 

15 (5) Section 223(f)(1) (as redesignated by para16 graph (3)) is amended by striking ‘‘calendar year 

17 2003’’ and inserting ‘‘calendar year 2014’’. 

18 (6) Section 26(b)(2)(U) of such Code is amend19 ed by striking ‘‘section 223(f)(4)’’ and inserting 

20 ‘‘section 223(e)(4)’’. 

21 (7) Sections 35(g)(3), 220(f)(5)(A), 

22 848(e)(1)(v), 4973(a)(5), and 6051(a)(12) of such 

23 Code are each amended by striking ‘‘section 223(d)’’ 

24 each place it appears and inserting ‘‘section 223(c)’’. 


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1 (8) Section 106(d)(1) of such Code is amend2 ed— 

3 (A) by striking ‘‘who is an eligible indi4 vidual (as defined in section 223(c)(1))’’; and 

5 (B) by striking ‘‘section 223(d)’’ and in6 serting ‘‘section 223(c)’’. 

7 (9) Section 408(d)(9) of such Code is amend8 ed— 

9 (A) in subparagraph (A) by striking ‘‘who 

10 is an eligible individual (as defined in section 

11 223(c)) and’’; and 

12 (B) in subparagraph (C) by striking ‘‘com13 puted on the basis of the type of coverage under 

14 the high deductible health plan covering the in15 dividual at the time of the qualified HSA fund16 ing distribution’’. 

17 (10) Section 877A(g)(6) of such Code is 

18 amended by striking ‘‘223(f)(4)’’ and inserting 

19 ‘‘223(e)(4)’’. 

20 (11) Section 4973(g) of such Code is amend21 ed— 

22 (A) by striking ‘‘section 223(d)’’ and in23 serting ‘‘section 223(c)’’; 


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1 (B) in paragraph (2), by striking ‘‘section 

2 223(f)(2)’’ and inserting ‘‘section 223(e)(2)’’; 

3 and 

4 (C) by striking ‘‘section 223(f)(3)’’ and in5 serting ‘‘section 223(e)(3)’’. 

6 (12) Section 4975 of such Code is amended— 

7 (A) in subsection (c)(6)— 

8 (i) by striking ‘‘section 223(d)’’ and 

9 inserting ‘‘section 223(c)’’; and 

10 (ii) by striking ‘‘section 223(e)(2)’’ 

11 and inserting ‘‘section 223(d)(2)’’; and 

12 (B) in subsection (e)(1)(E), by striking 

13 ‘‘section 223(d)’’ and inserting ‘‘section 

14 223(c)’’. 

15 (13) Section 6693(a)(2)(C) of such Code is 

16 amended by striking ‘‘section 223(h)’’ and inserting 

17 ‘‘section 223(g)’’. 

18 (h) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to taxable years beginning after 

20 December 31, 2018. 

21 SEC. 3. HSA ROLLOVER TO MEDICARE ADVANTAGE MSA. 

22 (a) IN GENERAL.—Section 138(b)(2) of the Internal 

23 Revenue Code of 1986 is amended by striking ‘‘or’’ at the 

24 end of subparagraph (A), by adding ‘‘or’’ at the end of 


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1 subparagraph (C), and by adding at the end the following 

2 new subparagraph: 

3 ‘‘(C) an HSA rollover contribution de4 scribed in subsection (d)(5),’’. 

5 (b) HSA ROLLOVER CONTRIBUTION.—Section 

6 138(c) of such Code is amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(5) ROLLOVER CONTRIBUTION.—An amount is 

9 described in this paragraph as a rollover contribu10 tion if it meets the requirement of subparagraphs 

11 (A) and (B). 

12 ‘‘(A) IN GENERAL.—The requirements of 

13 this subparagraph are met in the case of an 

14 amount paid or distributed from a health sav15 ings to the account beneficiary to the extent the 

16 amount is received is paid into a Medicare Ad17 vantage MSA of such beneficiary not later than 

18 the 60th day after the day on which the bene19 ficiary receives the payment or distribution. 

20 ‘‘(B) LIMITATION.—This paragraph shall 

21 not apply to any amount described in subpara22 graph (A) received by an individual from a 

23 health savings account if, at any time during 

24 the 1-year period ending on the day of such re25 ceipt, such individual received any other amount 


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1 described in subparagraph (A) from a health 

2 savings account which was not includible in the 

3 individual’s gross income because of the appli4 cation of section 223(e)(5)(A).’’. 

5 (c) CONFORMING AMENDMENT.—Section 

6 223(e)(5)(A) of such Code, as amended by section 2, is 

7 amended by inserting ‘‘or Medicare Advantage MSA’’ 

8 after ‘‘into a health savings account’’. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to taxable years beginning after 

11 December 31, 2018. 

12 SEC. 4. TREATMENT OF DIRECT PRIMARY CARE SERVICE 

13 ARRANGEMENT FEES AS MEDICAL EXPENSE. 

14 (a) IN GENERAL.—Section 223(c)(2)(C) of the Inter15 nal Revenue Code of 1986, as amended by the preceding 

16 provisions of this Act, is amended by striking ‘‘or’’ at the 

17 end of clause (iii), by striking the period at the end of 

18 clause (iv) and inserting ‘‘, or’’, and by adding at the end 

19 the following new clause: 

20 ‘‘(v) any direct primary care service arrangement.’’. 

21 (b) DIRECT PRIMARY CARE SERVICE ARRANGE22 MENT.—Section 223(c) of such Code, as amended by the 

23 preceding provisions of this Act, is amended by redesig24 nating paragraph (4) as paragraph (5) and by inserting 

25 after paragraph (3) the following new paragraph: 


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1 ‘‘(4) DIRECT PRIMARY CARE SERVICE AR2 RANGEMENT.—For purposes of this paragraph— 

3 ‘‘(A) IN GENERAL.—The term ‘direct pri4 mary care service arrangement’ means, with re5 spect to any individual, an arrangement under 

6 which such individual is provided medical care 

7 (as defined in section 213(d)) consisting solely 

8 of primary care services (as defined in section 

9 1833(x)(2)(B) of the Social Security Act) pro10 vided by primary care practitioners (as defined 

11 in section 1833(x)(2)(A) of the Social Security 

12 Act, determined without regard to clause (ii) 

13 thereof), if the sole compensation for such care 

14 is a fixed periodic fee. 

15 ‘‘(B) LIMITATION.—With respect to any 

16 individual for any month, such term shall not 

17 include any arrangement if the aggregate fees 

18 for all direct primary care service arrangements 

19 (determined without regard to this subclause) 

20 with respect to such individual for such month 

21 exceed $150 (twice such dollar amount in the 

22 case of an individual with any direct primary 

23 care service arrangement (as so determined) 

24 that covers more than one individual). 


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1 ‘‘(C) CERTAIN SERVICES SPECIFICALLY

2 EXCLUDED FROM TREATMENT AS PRIMARY

3 CARE SERVICES.—For purposes of this para4 graph, the term ‘primary care services’ shall not 

5 include— 

6 ‘‘(i) procedures that require the use of 

7 general anesthesia, 

8 ‘‘(ii) prescription drugs (other than 

9 vaccines), and 

10 ‘‘(iii) laboratory services not typically 

11 administered in an ambulatory primary 

12 care setting. 

13 The Secretary, after consultation with the Sec14 retary of Health and Human Services, shall 

15 issue regulations or other guidance regarding 

16 the application of this subparagraph.’’. 

17 (c) INFLATION ADJUSTMENT.—Section 223(g)(1) of 

18 such Code is amended— 

19 (1) by striking ‘‘and (c)(2)(A)’’ and inserting ‘‘, 

20 (c)(2)(A), and (c)(4)(B)’’, and 

21 (2) in subparagraph (B), by striking ‘‘clause 

22 (ii)’’ and inserting ‘‘clauses (ii) and (iii)’’ in clause 

23 (i), by striking ‘‘and’’ at the end of clause (i), by 

24 striking the period at the end of clause (ii) and inVerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4651.IH H4651

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1 serting ‘‘, and’’, and by inserting after clause (ii) the 

2 following new clause: 

3 ‘‘(iii) in the case of the dollar amount 

4 in subsection (c)(4)(B) for taxable years 

5 beginning in calendar years after 2019, 

6 ‘calendar year 2018’.’’. 

7 (d) REPORTING OF DIRECT PRIMARY CARE SERVICE

8 ARRANGEMENT FEES ON W–2.—Section 6051(a) of such 

9 Code is amended by striking ‘‘and’’ at the end of para10 graph (16), by striking the period at the end of paragraph 

11 (17) and inserting ‘‘, and’’, and by inserting after para12 graph (17) the following new paragraph: 

13 ‘‘(18) in the case of a direct primary care serv14 ice arrangement (as defined in section 223(c)(4)) 

15 which is provided in connection with employment, 

16 the aggregate fees for such arrangement for such 

17 employee.’’. 

18 (e) EFFECTIVE DATE.—The amendments made by 

19 this subsection shall apply to months beginning after De20 cember 31, 2018, in taxable years ending after such date. 


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1 SEC. 5. ALLOWING CERTAIN INDIVIDUALS WITH ALTER2 NATIVE HEALTH COVERAGE TO CHOOSE TO 

3 OPT OUT OF THE MEDICARE PART A BEN4 EFIT. 

5 (a) IN GENERAL.—Any individual described in sub6 section (c) who is otherwise entitled to benefits under part 

7 A of title XVIII of the Social Security Act may elect (in 

8 such form and manner as may be specified by the Commis9 sioner of Social Security, in consultation with the Sec10 retary of Health and Human Services) to opt out of such 

11 entitlement. Notwithstanding any other provision of law, 

12 in the case of an individual who makes such an election, 

13 such individual— 

14 (1) may (in such form and manner as may be 

15 specified by the Commissioner, in consultation with 

16 the Secretary) subsequently choose to end such elec17 tion and opt back into such entitlement (in accord18 ance with a process determined by the Commis19 sioner, in consultation with the Secretary) without, 

20 subject to subsection (b), being subject to any pen21 alty; 

22 (2) shall not be required to opt out of benefits 

23 under title II of such Act as a condition for making 

24 such election; and 


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1 (3) shall not be required to repay any amount 

2 paid under such part A for items and services fur3 nished prior to making such election. 

4 (b) NOTIFICATION OF TERMINATION OF QUALIFYING

5 ALTERNATIVE HEALTH COVERAGE REQUIRED.— 

6 (1) NOTIFICATION.—In the case of an indi7 vidual who makes an election under subsection (a) 

8 and whose enrollment in qualifying alternative 

9 health coverage is subsequently terminated, such in10 dividual shall notify the Secretary of Health and 

11 Human Services of such termination not later than 

12 60 days after the date of such termination. 

13 (2) LATE ENROLLMENT PENALTY.—If an indi14 vidual required to notify the Secretary under para15 graph (1) fails to provide such notification within 

16 the period specified under such paragraph and sub17 sequently chooses to end the election made by such 

18 individual under subsection (a) and opt back into 

19 benefits under part A of title XVIII of the Social Se20 curity Act, such individual shall be subject to a late 

21 enrollment penalty (as determined by the Secretary) 

22 in a manner and amount similar to an individual en23 rolled under such part A pursuant to section 1818 

24 of such Act (42 U.S.C. 1395i–2). 

25 (c) INDIVIDUAL DESCRIBED.— 


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1 (1) IN GENERAL.—For purposes of this section, 

2 an individual described in this subsection is an indi3 vidual who demonstrates (in accordance with a proc4 ess determined by the Commissioner, in consultation 

5 with the Secretary) that the individual is enrolled 

6 under qualifying alternative health coverage. 

7 (2) QUALIFYING ALTERNATIVE HEALTH COV8 ERAGE.—For purposes of this section, the term 

9 ‘‘qualifying alternative health coverage’’ includes a 

10 group health plan or health insurance coverage of11 fered in the group or individual market (as such 

12 terms are defined in section 2791 of the Public 

13 Health Service Act (42 U.S.C. 300gg–91), or other 

14 health coverage specified by the Commissioner, in 

15 consultation with the Secretary, that provides at 

16 least benefits comparable to benefits provided under 

17 part A of title XVIII of the Social Security Act. 

Æ 


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