I 

111TH CONGRESS 

1ST SESSION H. R. 3478 

To amend the Internal Revenue Code of 1986 to modify rules relating to 

health savings accounts, to provide payments for a health savings account 

and for a high deductible health plan instead of entitlement to benefits 

under Medicare, Medicaid, and SCHIP, to give more control and coverage 

to patients, to lower health care costs through increased price transparency, and to require immigrants to have a health savings account 

and high deductible health coverage at time of admission. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2009 

Mr. GOHMERT introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce and the Judiciary, 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 amend the Internal Revenue Code of 1986 to modify 

rules relating to health savings accounts, to provide payments for a health savings account and for a high deductible health plan instead of entitlement to benefits 

under Medicare, Medicaid, and SCHIP, to give more 

control and coverage to patients, to lower health care 

costs through increased price transparency, and to require immigrants to have a health savings account and 

high deductible health coverage at time of admission. 


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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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Patient-Controlled Healthcare Protection Act of 2009’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—HEALTH SAVINGS ACCOUNT REFORM 

Sec. 101. Advantage HSA. 

Sec. 102. Health Savings Account reform. 

Sec. 103. Advantage HSA grant program. 

Sec. 104. Health Savings Account debit card. 

Sec. 105. HSA Healthcare Panel. 

TITLE II—TRANSPARENCY RELATED TO HEALTH CARE 

PROVIDER CHARGES 

Sec. 201. Transparency requirements related to health care provider charges. 

TITLE III—IMMIGRATION-RELATED PROVISIONS 

Sec. 301. Requirement for immigrant to be covered under high deductible 

health plan and HSA. 

Sec. 302. Reentry of removed alien who received emergency medical assistance. 

8 TITLE I—HEALTH SAVINGS 

9 ACCOUNT REFORM 

10 SEC. 101. ADVANTAGE HSA. 

11 (a) IN GENERAL.—Part III of subchapter B of chap12 ter 1 of the Internal Revenue Code of 1986 is amended 

13 by inserting after section 138 the following new section: 

14 ‘‘SEC. 138A. ADVANTAGE HSA. 

15 ‘‘(a) IN GENERAL.—Gross income shall not include 

16 any payment to the Advantage HSA of an individual by 

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1 tient-Controlled Healthcare Protection Act of 2009 or any 

2 premium payment under such section for the high deduct3 ible health plan with respect to which such Advantage 

4 HSA relates. 

5 ‘‘(b) ADVANTAGE HSA.—For purposes of this sec6 tion, the term ‘Advantage HSA’ means a health savings 

7 account (as defined in section 223(d))— 

8 ‘‘(1) which is designated as an Advantage HSA, 

9 ‘‘(2) with respect to which no contribution may 

10 be made other than— 

11 ‘‘(A) a contribution described in subsection 

12 (a), 

13 ‘‘(B) a contribution in cash without limita14 tion as to amount, or 

15 ‘‘(C) a trustee-to-trustee transfer described 

16 in subsection (d), and 

17 ‘‘(3) the governing instrument of which pro18 vides that trustee-to-trustee transfers described in 

19 subsection (d) may be made to and from such ac20 count. 

21 ‘‘(c) TEN PERCENT BONUS DISTRIBUTION.— 

22 ‘‘(1) IN GENERAL.—Section 223(f)(2) shall not 

23 apply to any bonus distribution from a health sav24 ings account. 


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1 ‘‘(2) DISTRIBUTIONS.—An eligible Advantage 

2 HSA participant may receive 10 percent of excess 

3 funds that have been contributed to the individual or 

4 household HSA over the deductible in a calendar 

5 year. The funds will be directly deposited into the 

6 desired account of the participant. 

7 ‘‘(3) BONUS DISTRIBUTION.—For purposes of 

8 this subsection, the term ‘bonus distribution’ means 

9 any distribution which is made during the 30-day 

10 period beginning on the first day of the calendar 

11 year to the extent such distribution does not exceed 

12 an amount equal to the excess (if any) of— 

13 ‘‘(A) the fair market value of the assets in 

14 such health savings account as of the close of 

15 the preceding calendar year, over 

16 ‘‘(B) the sum of the annual deductible re17 quired to be paid under the plan for covered 

18 benefits for the calendar year. 

19 ‘‘(d) STATE CERTIFICATION FOR HIGH DEDUCTIBLE

20 HEALTH PLANS.—For purposes of this section— 

21 ‘‘(1) IN GENERAL.—For purposes of deter22 mining whether or not an individual is an eligible in23 dividual, a health plan shall not be treated as a high 

24 deductible health plan (as defined under section 

25 223(c)(2)) unless such plan is certified by the State 


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1 within which the individual’s principal place of abode 

2 is located. 

3 ‘‘(2) INSURANCE BIDDING.—If an insurance 

4 company is based in the United States, they may 

5 offer and sell policies in all States and they may bid 

6 on other policies across State lines. 

7 ‘‘(e) TRUSTEE-TO-TRUSTEE TRANSFER.—Section 

8 223(f)(2) shall not apply to any trustee-to-trustee transfer 

9 from an Advantage HSA of an account holder to another 

10 Advantage HSA or health savings account of such account 

11 holder. 

12 ‘‘(f) ASSOCIATIONS.—Employers who choose to par13 ticipate in the Advantage HSA Program may join together 

14 in associations in an effort to purchase less expensive in15 surance for their employees.’’. 

16 (b) CONFORMING AMENDMENT.—The table of sec17 tions for part III of subchapter B of chapter 1 of such 

18 Code is amended by inserting after the item relating to 

19 section 138 the following new item: 

‘‘138A. Advantage HSA.’’. 

20 (c) EFFECTIVE DATE.—The amendments made by 

21 this section shall apply to taxable years beginning after 

22 December 31, 2009. 

23 SEC. 102. HEALTH SAVINGS ACCOUNT REFORM. 

24 (a) ACCOUNT-TO-ACCOUNT TRANSFERS.— 


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1 (1) IN GENERAL.—Subparagraph (A) of section 

2 223(f)(5) of the Internal Revenue Code of 1986 is 

3 amended by striking ‘‘a health savings account for 

4 the benefit of such beneficiary’’ and inserting ‘‘any 

5 health savings account’’. 

6 (2) LIMITATION.—Subparagraph (B) of section 

7 223(f)(5) of such Code is amended— 

8 (A) by striking ‘‘LIMITATION.—This para9 graph’’ and inserting the following: 

10 ‘‘(B) LIMITATIONS.— 

11 ‘‘(i) IN GENERAL.—This paragraph’’, 

12 and 

13 (B) by adding at the end of subparagraph 

14 (B), as so amended, the following new clause: 

15 ‘‘(ii) TRANSFERS TO OTHER ACCOUNT

16 BENEFICIARIES.—This paragraph shall not 

17 apply to any amount described in subpara18 graph (A) to the extent that immediately 

19 after such distribution the fair market 

20 value of the account is less than the an21 nual deductible required to be paid under 

22 the plan for the calendar year within which 

23 the distribution is made.’’. 


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1 (b) MIGRANT WORKER HSA.—Section 223 of such 

2 Code is amended by adding at the end the following new 

3 subsection: 

4 ‘‘(i) MIGRANT WORKER HSA.— 

5 ‘‘(1) IN GENERAL.—An employer may establish 

6 for the benefit of any eligible employee a health sav7 ings account. 

8 ‘‘(2) ELIGIBLE EMPLOYEE.—For purposes of 

9 this subsection, the term ‘eligible employee’ means 

10 any individual (other than a citizen or resident of 

11 the United States)— 

12 ‘‘(A) with respect to whom the employee 

13 provides remuneration for employment, and 

14 ‘‘(B) who is lawfully present in the United 

15 States and has been granted authorization to 

16 engage in employment in the United States.’’. 

17 (c) OTHER REFORMS.—Section 223 of such Code is 

18 amended as follows: 

19 (1) By striking paragraphs (1) through (4) and 

20 (6) through (8) of subsection (b) and by redesig21 nating paragraph (5) as paragraph (1). 

22 (2) By inserting after paragraph (1), as so re23 designated, the following new paragraph: 

24 ‘‘(2) HOUSEHOLD HSA.—In the case of health 

25 savings accounts with respect to which individuals 


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1 who are members of the same household are the ac2 count beneficiaries, upon filing the return of tax for 

3 any taxable year, each such individual shall include 

4 on the return each social security number of all par5 ticipating members of such individual’s household.’’. 

6 (3) By amending paragraph (1) of subsection 

7 (c) to read as follows: 

8 ‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

9 individual’ means any individual.’’. 

10 (4) By amending subsection (c)(2)(A) to read 

11 as follows: 

12 ‘‘(A) IN GENERAL.—The term ‘high de13 ductible health plan’ means a health plan which 

14 has an annual deductible which is not less 

15 than— 

16 ‘‘(i) $2,500 for self-only coverage, and 

17 ‘‘(ii) $3,500 for family or household 

18 coverage.’’. 

19 (5) By striking subparagraph (B) of subsection 

20 (c)(2) and redesignating subparagraphs (C) and (D) 

21 thereof as subparagraphs (B) and (C), respectively. 

22 (6) By adding at the end of subsection (c)(2), 

23 as so amended, the following new subparagraph: 


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1 ‘‘(D) OTHER REQUIREMENTS.—An Advan2 tage HSA plan will offer the following to the in3 dividual or household participants— 

4 ‘‘(i) the plan shall not require that an 

5 individual see a general physician prior to 

6 a seeing specialist, and 

7 ‘‘(ii) coverage may not be denied 

8 based on a pre-existing condition of an in9 dividual.’’. 

10 (7) By adding at the end of subparagraph (A) 

11 of subsection (d)(2) the following: ‘‘Such term shall 

12 include any expense which is on the list of eligible 

13 healthcare expenses most recently submitted by the 

14 HSA Healthcare Panel under section 105(b)(2) of 

15 the Patient-Controlled Healthcare Protection Act of 

16 2009.’’. 

17 (8) By striking ‘‘the individual’’ in subsection 

18 (d)(3) and inserting ‘‘an individual’’. 

19 (9) By adding at the end of subsection (e) the 

20 following new paragraph: 

21 ‘‘(3) EXCEPTION.—In the case of a termination 

22 occurring after the date of the enactment of the Pa23 tient-Controlled Healthcare Protection Act of 2009, 

24 in lieu of being treated as a distribution not used to 

25 pay qualified medical expenses, such amounts shall 


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1 be transferred by the account beneficiaries to an2 other health savings account.’’. 

3 (10) In subsection (f), by striking paragraphs 

4 (2), (3), (5), and (8) of and redesignating para5 graphs (4), (6), and (7) as paragraphs (2), (3), and 

6 (4), respectively. 

7 (11) By amending paragraph (2) of subsection 

8 (f), as so redesignated, to read as follows: 

9 ‘‘(2) AMOUNTS NOT USED FOR QUALIFIED MED10 ICAL EXPENSES.—Any amount paid or distributed 

11 out of a health savings account which is not used ex12 clusively to pay the qualified medical expenses of an 

13 account beneficiary shall be recontributed by the 

14 beneficiary to such health savings account.’’. 

15 (12) By adding at the end (as amended by this 

16 Act) the following new subsection: 

17 ‘‘(j) OTHER SPECIAL RULES.—For purposes of this 

18 section— 

19 ‘‘(1) INVESTMENT OF HSA FUNDS.—Account 

20 beneficiaries may invest any amount in their health 

21 savings account in excess of their deductible in infla22 tion-proof United States bonds. 

23 ‘‘(2) TERMINATION OF HOUSEHOLD.—Any ac24 count beneficiaries of a household HSA shall sign an 

25 agreement as to distribution of amounts from such 


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1 HSA prior to termination of the HSA, which will be 

2 kept on file with the entity in which the HSA funds 

3 are being held. 

4 ‘‘(3) PORTABILITY.—An individual or household 

5 participant owns their HSA and insurance policy (if 

6 they choose to have one) and therefore the policies 

7 are portable.’’. 

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

9 this section shall apply to taxable years beginning after 

10 December 31, 2009. 

11 SEC. 103. ADVANTAGE HSA PAYMENT PROGRAM. 

12 (a) IN GENERAL.—The Advantage HSA payment 

13 program provided under this section shall be in lieu of en14 titlement to, and eligibility for, benefits and assistance de15 scribed in subsection (d)(2). Effective on the date the Ad16 vantage HSA payment program is established, titles 

17 XVIII, XIX, and XXI of the Social Security Act are re18 pealed, except for purposes of determining whether an in19 dividual is an Advantage eligible individual under this sec20 tion. 

21 (b) HSA CONTRIBUTIONS.—In the case of an indi22 vidual or household who is eligible for an Advantage HSA, 

23 the Secretary of Treasury, in consultation with the Sec24 retary of Health and Human Services, shall pay an annual 


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1 amount to the Advantage HSA of the individual or house2 hold. 

3 (c) HSA PREMIUM ASSISTANCE.—The Secretary of 

4 the Treasury, in consultation with the Secretary of Health 

5 and Human Services, shall establish a program under 

6 which the Secretary of the Treasury shall pay the pre7 miums for the high deductible health plan with respect to 

8 the Advantage HSA of such individual. Such program 

9 shall provide for prorated payment of such premiums in 

10 the case that such individual is not an Advantage eligible 

11 individual for a full calendar year. 

12 (d) ADVANTAGE ELIGIBLE INDIVIDUAL.—For pur13 poses of this section— 

14 (1) IN GENERAL.—The term ‘‘Advantage eligi15 ble individual’’ means, with respect to any month, 

16 any individual— 

17 (A) who is an eligible individual (as de18 fined in section 223(c) of the Internal Revenue 

19 Code of 1986); and 

20 (B)(i) who is Advantage eligible; or 

21 (ii) whose dependent (within the meaning 

22 of section 152 of the Internal Revenue Code of 

23 1986) or spouse is Advantage eligible (but only 

24 if an election under this section is in effect with 

25 respect to such spouse or dependent). 


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1 (2) ADVANTAGE ELIGIBLE.—The term ‘‘Advan2 tage eligible’’ means, with respect to any month— 

3 (A) entitled, as of the 1st day of such 

4 month, to benefits under part A of title XVIII 

5 of the Social Security Act or to enroll under 

6 part B of such title, or 

7 (B) eligible, as of the 1st day of such 

8 month, for medical or child health assistance 

9 under title XIX or XXI of such Act (other than 

10 under section 1928 of such Act). 

11 (e) APPLICABLE ANNUAL AMOUNT.—For purposes of 

12 this section— 

13 (1) IN GENERAL.—The term ‘‘applicable annual 

14 amount’’ means $2,500. 

15 (2) ADDITIONAL AMOUNT.—In the case of an 

16 Advantage HSA eligible household, $3,500. 

17 (f) DEFINITIONS.—Except as otherwise provided, 

18 terms used in this section shall have the same respective 

19 meanings as when used in sections 138A and 223 of the 

20 Internal Revenue Code of 1986. 

21 (g) REGULATIONS.—The Secretary of the Treasury 

22 shall prescribe such regulations as may be necessary or 

23 appropriate to carry out the purposes of this section, in24 cluding regulations providing for the following: 


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1 (1) Recapture of amounts paid under sub2 section (a) (and any earnings attributable thereto) 

3 which are distributed out of an Advantage HSA and 

4 not used exclusively to pay qualified medical ex5 penses of the account beneficiary. 

6 (2) Ensuring that not more than the applicable 

7 annual amount under paragraph (1) of subsection 

8 (d) (and any additional amount under paragraph (2) 

9 of such subsection) shall be paid with respect to any 

10 individual, the spouse of such individual, and all de11 pendents with respect to such individual. 

12 (3) Ensuring that all individuals with respect to 

13 whom an election has been made under this section 

14 are covered under the high deductible plan to which 

15 the applicable Advantage HSA relates. 

16 SEC. 104. HEALTH SAVINGS ACCOUNT DEBIT CARD. 

17 (a) IN GENERAL.—The Secretary of the Treasury, in 

18 consultation with the Secretary of Health and Human 

19 Services, shall establish a program under which trustees 

20 of health savings accounts can issue debit cards with 

21 which account beneficiaries may pay for qualified medical 

22 expenses (as defined in section 223 of the Internal Rev23 enue Code of 1986). Such program shall provide for the 

24 following: 


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1 (1) Participation from health care providers 

2 and vendors of products the purchase of which quali3 fies as a qualified medical expense (as so defined). 

4 (2) A uniform coding system implemented by 

5 such providers and vendors such that such debit 

6 cards may not be used to purchase services or prod7 ucts which are not qualified medical expenses (as so 

8 defined). 

9 (3) That prior to payment with such card such 

10 providers and vendors require presentation an identi11 fication card that matches the individual identified 

12 on the debit card and provides a photograph and is 

13 issued by a State or the Federal Government, or a 

14 document that, with respect to identification of the 

15 individual identified on the debit card, is considered 

16 acceptable for purposes of sections 

17 274a.2(b)(1)(v)(A) and 274a.2(b)(1)(v)(B) of title 8, 

18 Code of Federal Regulations (as in effect on or after 

19 the date of the enactment of this Act). 

20 (4) That the individual presenting such debit 

21 card for payment sign a statement that affirms pay22 ment is for a qualified medical expense with respect 

23 to such individual and which acknowledges that use 

24 of such debit card for any other expense constitutes 

25 a false statements or misrepresentations which may 


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1 subject the purchaser to criminal penalties under 

2 section 1001 of title 18, United States Code, which 

3 notice specifies the maximum fine and term of im4 prisonment under such section. 

5 (b) SUBMISSION OF INFORMATION.—Each trustee of 

6 a health savings account shall submit to the HSA 

7 Healthcare Panel (established under section 105) a report 

8 detailing all purchases made with debit cards from health 

9 savings accounts of the trustee. Such report shall not con10 tain any personal information of the account beneficiaries 

11 of such health savings accounts. 

12 (c) HEALTH SAVINGS ACCOUNT; QUALIFIED MED13 ICAL EXPENSES.—For purposes of this section, the terms 

14 ‘‘health savings account’’ and ‘‘qualified medical ex15 penses’’ shall have the respective meanings given such 

16 terms by section 223 of the Internal Revenue Code of 

17 1986. 

18 SEC. 105. HSA HEALTHCARE PANEL. 

19 (a) ESTABLISHMENT.—There is established a Panel 

20 to be known as the ‘‘HSA Healthcare Panel’’ (in this sec21 tion referred to as the ‘‘Panel’’). 

22 (b) DUTIES.— 

23 (1) REVIEW OF QUALIFIED MEDICAL EX24 PENSES.—The Panel shall review the reports and 

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1 tion 104 or requested by the Panel and review ap2 propriate information regarding the healthcare treat3 ments, services, and products that are potentially 

4 treatable as qualified medical expenses for purposes 

5 of section 223 of the Internal Revenue Code of 

6 1986. 

7 (2) REPORT.—The Panel shall, not later than 

8 1 year after the date of enactment of this Act and 

9 annually thereafter submit a report to Congress pro10 viding a new list of eligible healthcare expenses. 

11 (c) MEMBERSHIP.— 

12 (1) IN GENERAL.—The Panel shall be com13 prised of 101 members. 

14 (2) APPOINTMENTS.— 

15 (A) VOTING MEMBER AND CHAIR.—The 

16 Surgeon General of the United States shall be 

17 a voting member of the Panel, and shall be the 

18 chairperson. 

19 (B) OTHER VOTING MEMBERS.—The Gov20 ernor of each State shall appoint 2 voting mem21 bers to the Panel, one of whom shall be a 

22 health care specialist and one of whom shall not 

23 be a health care specialist. 

24 (3) DATE OF APPOINTMENTS.—The appoint25 ment of a members of the Panel shall be made not 


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1 later than 60 days after the date of the enactment 

2 of this Act. 

3 (4) TERM.—Members shall be appointed for 1- 

4 year terms. 

5 (5) VACANCIES.—A vacancy in the Panel shall 

6 be filled not later than 60 days after such vacancy 

7 occurs and in the manner in which the original ap8 pointment was made. 

9 (d) POWERS OF PANEL.— 

10 (1) MEETINGS AND HEARINGS.— 

11 (A) IN GENERAL.—The Panel shall meet 

12 upon the call of the chairperson or a majority 

13 of its voting members. Such meetings, to the 

14 extent practicable, may be conducted over the 

15 internet or in person. 

16 (B) HEARINGS.—The Panel may, for the 

17 purpose of carrying out this section, hold hear18 ings, sit and act at times and places, take testi19 mony, and receive evidence to carry out its du20 ties under this section. The Panel may admin21 ister oaths or affirmations to witnesses appear22 ing before it. 

23 (2) OBTAINING OFFICIAL INFORMATION.— 

24 (A) REQUIREMENT TO FURNISH.—Except 

25 as provided in subparagraph (B), if the Panel 


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1 submits a request to a Federal department or 

2 agency for information necessary to enable the 

3 Panel to carry out this section, the head of that 

4 department or agency shall furnish that infor5 mation to the Panel. 

6 (B) EXCEPTION FOR NATIONAL SECU7 RITY.—If the head of a Federal department or 

8 agency determines that it is necessary to with9 hold requested information from disclosure to 

10 protect the national security interests of the 

11 United States, the department or agency head 

12 shall not furnish that information to the Panel. 

13 (3) MAILS.—The Panel may use the United 

14 States mails in the same manner and under the 

15 same conditions as other departments and agencies 

16 of the United States. 

17 (4) CONTRACTS.—The Panel may contract with 

18 and compensate persons and government agencies 

19 for supplies and services, without regard to section 

20 3709 of the Revised Statutes (41 U.S.C. 5). 

21 (e) PAY AND REIMBURSEMENT.— 

22 (1) NO COMPENSATION FOR MEMBERS OF

23 PANEL.—Except as provided in paragraph (2), a 

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1 ances, or benefits by reason of the member’s service 

2 on the Panel. 

3 (2) TRAVEL EXPENSES.—Each member shall 

4 receive travel expenses, including per diem in lieu of 

5 subsistence under subchapter I of chapter 57 of title 

6 5, United States Code. 

7 (f) QUORUM.—Thirty members of the Panel shall 

8 constitute a quorum, but a lesser number may hold hear9 ings. 

10 TITLE II—TRANSPARENCY RE11 LATED TO HEALTH CARE 

12 PROVIDER CHARGES 

13 SEC. 201. TRANSPARENCY REQUIREMENTS RELATED TO 

14 HEALTH CARE PROVIDER CHARGES. 

15 (a) IN GENERAL.—Notwithstanding any other provi16 sion of law, a health care provider shall provide to an indi17 vidual who is scheduled to receive a service or treatment 

18 the following: 

19 (1) ACTUAL PRICES TO BE CHARGED.—The ac20 tual price that the health care provider will charge 

21 for the service or treatment. 

22 (2) PAYMENT RATES APPLICABLE TO OTHER

23 ENTITIES.—In the case such charge amount for the 

24 service or treatment is different from— 


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1 (A) the rate of payment for the service or 

2 treatment to the health care provider that has 

3 been negotiated by or on behalf of the provider 

4 with a network plan or managed care plan; 

5 (B) the rate of payment for the service or 

6 treatment applicable to the provider under the 

7 Medicare program under title XVIII; or 

8 (C) such charge amount or payment rate 

9 that is applicable with respect to any other enti10 ty; 

11 the amount of such different rate of payment or 

12 charge amount and a description of the type of enti13 ty to which such rate or charge applies (without 

14 naming such entity). 

15 (b) APPLICATION OF REQUIREMENT ON REQUEST.— 

16 A health care provider is required to provide the applicable 

17 information under subsection (a) for a service or treat18 ment when requested by anyone in person, or by phone, 

19 fax, or email. 

20 (c) CLARIFICATION.—Nothing in this section shall be 

21 construed as preventing a health care provider from pro22 viding a service or treatment free of charge as a charitable 

23 gesture without publicly disclosing the individual to whom 

24 such charitable service or treatment has been provided. 


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1 (d) EFFECTIVE DATE.—The requirement under sub2 section (a) shall apply with respect to services and treat3 ments provided on or after the date that is 60 days after 

4 the date of the enactment of this Act. 

5 TITLE III—IMMIGRATION6 RELATED PROVISIONS 

7 SEC. 301. REQUIREMENT FOR IMMIGRANT TO BE COVERED 

8 UNDER HIGH DEDUCTIBLE HEALTH PLAN 

9 AND HSA. 

10 Notwithstanding any other provision of law, a con11 sular officer (as defined in section 101(a) of the Immigra12 tion and Nationality Act (8 U.S.C. 1101(a)) may not issue 

13 or renew an immigrant visa to an alien unless the alien 

14 presents evidence (which may be in the form of an attesta15 tion by a sponsoring employer or individual United States 

16 citizen in whose household the alien intends to reside who 

17 will be responsible for providing the requisite coverage) 

18 that the alien (and the alien’s spouse and children who 

19 are accompanying or following to join the alien) will be 

20 covered under a high deductible health plan (as defined 

21 in section 223 of the Internal Revenue Code of 1986) and 

22 will be an account beneficiary of a health savings account 

23 under such section after the alien’s admission to the 

24 United States as an immigrant and for the duration of 


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1 the alien’s residence in the United States, or be subject 

2 to removal. 

3 SEC. 302. REENTRY OF REMOVED ALIEN WHO RECEIVED 

4 EMERGENCY MEDICAL ASSISTANCE. 

5 Section 276(b) of the Immigration and Nationality 

6 Act (8 U.S.C. 1326(b)) is amended— 

7 (1) in paragraph (3), by striking ‘‘. or’’ at the 

8 end; 

9 (2) in paragraph (4), by striking the period at 

10 the end and inserting ‘‘; or’’; and 

11 (3) by adding at the end the following: 

12 ‘‘(5) whose removal was subsequent to the pro13 vision of medical assistance pursuant to section 

14 401(b)(1)(A) of the Personal Responsibility and 

15 Work Opportunity Act of 1996 (8 U.S.C. 

16 1611(b)(1)(A)), such alien shall be fined under title 

17 18, United States Code, imprisoned not more than 

18 10 years, or both.’’. 

Æ 


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