I 

118TH CONGRESS 

1ST SESSION H. R. 5608 

To allow individuals to elect to receive contributions to a health savings 

account in lieu of reduced cost-sharing under health insurance obtained 

through a health insurance Exchange. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 20, 2023 

Mr. STEUBE (for himself and Mrs. CAMMACK) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To allow individuals to elect to receive contributions to a 

health savings account in lieu of reduced cost-sharing 

under health insurance obtained through a health insurance Exchange. 

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 ‘‘Affordable Care and 

5 Comprehensive Economic Support through Savings Act’’ 

6 or the ‘‘ACCESS Act’’. 


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1 SEC. 2. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN 

2 LIEU OF REDUCED COST-SHARING. 

3 (a) IN GENERAL.—Section 223 of the Internal Rev4 enue Code of 1986 is amended by adding at the end the 

5 following new subsection: 

6 ‘‘(i) HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN

7 LIEU OF REDUCED COST-SHARING FOR EXCHANGE-PRO8 VIDED PLANS.— 

9 ‘‘(1) IN GENERAL.—In the case of any eligible 

10 insured who is enrolled in an Exchange-provided 

11 high deductible health plan for any month and who 

12 elects (at such time and in such manner as the Sec13 retary may provide) the application of this sub14 section— 

15 ‘‘(A) section 1402 of the Patient Protec16 tion and Affordable Care Act shall not apply to 

17 such individual for such month, 

18 ‘‘(B) the health insurance issuer offering 

19 such plan shall make a payment to a health 

20 savings account of such individual for such 

month in an amount equal to 1 21 ⁄12 of the annual 

22 reduced cost-sharing actuarial equivalent 

23 amount, and 

24 ‘‘(C) the Secretary shall make payments to 

25 such health insurance issuer in amounts which 


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1 are equal to the payments made by such issuer 

2 under subparagraph (B). 

3 ‘‘(2) ANNUAL REDUCED COST-SHARING ACTU4 ARIAL EQUIVALENT AMOUNT.—For purposes of this 

5 section, the term ‘annual reduced cost-sharing actu6 arial equivalent amount’ means, with respect to any 

7 Exchange-provided high deductible health plan en8 rolled in by an eligible insured, an amount that 

9 would produce an actuarial value equal to the actu10 arial value of the reduction in cost-sharing (as deter11 mined under section 1402 of the Patient Protection 

12 and Affordable Care Act and without regard to any 

13 election under this subsection) for the plan year de14 termined by taking into account the household in15 come of the eligible insured. 

16 ‘‘(3) RESTRICTION ON DISTRIBUTIONS.— 

17 ‘‘(A) IN GENERAL.—Any trust which re18 ceives a payment described in paragraph (1)(B) 

19 shall not be treated as a health savings account 

20 for purposes of this section unless the terms of 

21 such trust require that, during any month dur22 ing which such a payment is received, no dis23 tribution may be made from such trust unless 

24 such distribution is made to satisfy a charge 

25 properly made to a qualified medical debit card. 


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1 ‘‘(B) QUALIFIED MEDICAL DEBIT CARD.— 

2 For purposes of this paragraph, the term 

3 ‘qualified medical debit card’ means a debit 

4 card which— 

5 ‘‘(i) is issued by a bank (as defined in 

6 section 408(n)), 

7 ‘‘(ii) is provided by the trustee of the 

8 health savings account to the designated 

9 beneficiary, and 

10 ‘‘(iii) is encoded in such a manner 

11 that the only expenses which may charged 

12 with such card are amounts paid for med13 ical care (as defined in section 213(d)). 

14 ‘‘(4) RECAPTURE OF EXCESS PAYMENTS.—For 

15 purposes of applying the recapture rules of section 

16 36B(f)(2)— 

17 ‘‘(A) payments made to the health savings 

18 account of an individual under paragraph 

19 (1)(B) shall be treated as an advance payment 

20 of the credit allowed under section 36B, and 

21 ‘‘(B) the credit allowed under section 36B 

22 shall be treated as having been increased by the 

23 payments which would have been made to the 

24 health savings account of such individual under 

25 paragraph (1)(B) if such payments had been 


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1 determined using the household income of such 

2 individual for the taxable year referred to in 

3 such section. 

4 ‘‘(5) OTHER DEFINITIONS AND SPECIAL

5 RULES.—For purposes of this section— 

6 ‘‘(A) EXCHANGE-PROVIDED HIGH DEDUCT7 IBLE HEALTH PLAN.—The term ‘Exchange-pro8 vided high deductible health plan’ means, with 

9 respect to any eligible insured, any high deduct10 ible health plan enrolled in by such eligible in11 sured through an Exchange established under 

12 the Patient Protection and Affordable Care Act. 

13 ‘‘(B) ELIGIBLE INSURED.—The term ‘eli14 gible insured’ has the meaning given such term 

15 in section 1402(b) of the Patient Protection 

16 and Affordable Care Act. 

17 ‘‘(C) COORDINATION WITH CONTRIBUTION

18 LIMITS; ETC.—The payments described in para19 graph (1)(B) shall not fail to be taken into ac20 count under this section as contributions to the 

21 health savings account to which paid and such 

22 payments shall not be required to be made to 

23 the extent that the eligible insured does not 

24 have a health savings account or such account 


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1 is prohibited from accepting such payment by 

2 reason of subsection (d)(1)(A)(ii).’’. 

3 (b) REQUIREMENTS RELATED TO EXCHANGE-PRO4 VIDED HIGH DEDUCTIBLE HEALTH PLANS.—Section 

5 1301(a) of the Patient Protection and Affordable Care Act 

6 (42 U.S.C. 18021(a)) is amended by adding at the end 

7 the following new paragraph: 

8 ‘‘(5) REQUIREMENTS RELATED TO HIGH DE9 DUCTIBLE HEALTH PLANS.— 

10 ‘‘(A) REQUIREMENT TO OFFER HIGH DE11 DUCTIBLE HEALTH PLAN AS ALTERNATIVE.—A 

12 health plan in the silver level of coverage in the 

13 individual market which is not a high deductible 

14 health plan shall not be treated as a qualified 

15 health plan unless the health insurance issuer 

16 offering such plan offers a high deductible 

17 health plan which is actuarially equivalent to 

18 such plan to any individual who would be an eli19 gible insured (as defined in section 1402(b)) if 

20 such individual were enrolled in such plan. 

21 ‘‘(B) REQUIREMENT TO MAKE HEALTH

22 SAVINGS ACCOUNT CONTRIBUTIONS UPON ELEC23 TION OF ELIGIBLE INSURED.—A high deduct24 ible health plan shall not be treated as a quali25 fied health plan unless the health insurance 


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1 issuer offering such plan complies with the re2 quirement of section 223(i)(1)(B) of such Code 

3 with respect to such plan. 

4 ‘‘(C) DETERMINATION OF ACTUARIAL

5 VALUE.—For purposes of this Act, the actuarial 

6 value of a high deductible health plan shall take 

7 into account payments made by the issuer to a 

8 health savings account of the enrollee pursuant 

9 to such plan. 

10 ‘‘(D) HIGH DEDUCTIBLE HEALTH PLAN.— 

11 For purposes of this paragraph, the term ‘high 

12 deductible health plan’ has the meaning given 

13 such term by section 223 of the Internal Rev14 enue Code of 1986.’’. 

15 (c) PUBLIC EDUCATION.—Beginning on January 1, 

16 2025, each health insurance issuer offering coverage 

17 through an Exchange established under the Patient Pro18 tection and Affordable Care Act, and each such Exchange, 

19 shall provide all prospective enrollees— 

20 (1) information regarding the availability of in21 surer-provided health savings account contributions 

22 in lieu of reduced cost-sharing for silver level high 

23 deductible health plans selected in the Exchange, 

24 and 


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1 (2) information regarding how to establish and 

2 use a health savings account. 

3 (d) PERMANENT APPROPRIATION FOR COST-SHAR4 ING REDUCTION PAYMENTS AND HSA CONTRIBUTIONS

5 MADE IN LIEU OF SUCH PAYMENTS.—Necessary amounts 

6 are appropriated to the Secretary of the Treasury for 

7 making payments described in section 1402(d)(3) of the 

8 Patient Protection and Affordable Care Act, and pay9 ments described in section 223(i)(1)(C) of the Internal 

10 Revenue Code of 1986 (as added by this section), for 

11 months beginning after December 31, 2024. 

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

13 this section shall apply to months beginning after Decem14 ber 31, 2024. 

Æ 


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