I 
119TH CONGRESS 
1ST SESSION H. R. 1157 
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 
FEBRUARY 10, 2025 
Mr. STEUBE (for himself and Mrs. CAMMACK) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 insur-
ance Exchange. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Affordable Care and 
Comprehensive Economic Support through Savings Act’’ 
or the ‘‘ACCESS Act’’. 
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SEC. 2. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN 
LIEU OF REDUCED COST-SHARING. 
(a) IN GENERAL.—Section 223 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following new subsection: 
‘‘(i) HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN 
LIEU OF REDUCED COST-SHARING FOR EXCHANGE-PRO-
VIDED PLANS.— 
‘‘(1) IN GENERAL.—In the case of any eligible 
insured who is enrolled in an Exchange-provided 
high deductible health plan for any month and who 
elects (at such time and in such manner as the Sec-
retary may provide) the application of this sub-
section— 
‘‘(A) section 1402 of the Patient Protec-
tion and Affordable Care Act shall not apply to 
such individual for such month, 
‘‘(B) the health insurance issuer offering 
such plan shall make a payment to a health 
savings account of such individual for such 
month in an amount equal to 1⁄12 of the annual 
reduced 
cost-sharing 
actuarial 
equivalent 
amount, and 
‘‘(C) the Secretary shall make payments to 
such health insurance issuer in amounts which 
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are equal to the payments made by such issuer 
under subparagraph (B). 
‘‘(2) ANNUAL REDUCED COST-SHARING ACTU-
ARIAL EQUIVALENT AMOUNT.—For purposes of this 
section, the term ‘annual reduced cost-sharing actu-
arial equivalent amount’ means, with respect to any 
Exchange-provided high deductible health plan en-
rolled in by an eligible insured, an amount that 
would produce an actuarial value equal to the actu-
arial value of the reduction in cost-sharing (as deter-
mined under section 1402 of the Patient Protection 
and Affordable Care Act and without regard to any 
election under this subsection) for the plan year de-
termined by taking into account the household in-
come of the eligible insured. 
‘‘(3) RESTRICTION ON DISTRIBUTIONS.— 
‘‘(A) IN GENERAL.—Any trust which re-
ceives a payment described in paragraph (1)(B) 
shall not be treated as a health savings account 
for purposes of this section unless the terms of 
such trust require that, during any month dur-
ing which such a payment is received, no dis-
tribution may be made from such trust unless 
such distribution is made to satisfy a charge 
properly made to a qualified medical debit card. 
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‘‘(B) QUALIFIED MEDICAL DEBIT CARD.— 
For purposes of this paragraph, the term 
‘qualified medical debit card’ means a debit 
card which— 
‘‘(i) is issued by a bank (as defined in 
section 408(n)), 
‘‘(ii) is provided by the trustee of the 
health savings account to the designated 
beneficiary, and 
‘‘(iii) is encoded in such a manner 
that the only expenses which may charged 
with such card are amounts paid for med-
ical care (as defined in section 213(d)). 
‘‘(4) RECAPTURE OF EXCESS PAYMENTS.—For 
purposes of applying the recapture rules of section 
36B(f)(2)— 
‘‘(A) payments made to the health savings 
account of an individual under paragraph 
(1)(B) shall be treated as an advance payment 
of the credit allowed under section 36B, and 
‘‘(B) the credit allowed under section 36B 
shall be treated as having been increased by the 
payments which would have been made to the 
health savings account of such individual under 
paragraph (1)(B) if such payments had been 
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determined using the household income of such 
individual for the taxable year referred to in 
such section. 
‘‘(5) 
OTHER
DEFINITIONS
AND
SPECIAL 
RULES.—For purposes of this section— 
‘‘(A) EXCHANGE-PROVIDED HIGH DEDUCT-
IBLE HEALTH PLAN.—The term ‘Exchange-pro-
vided high deductible health plan’ means, with 
respect to any eligible insured, any high deduct-
ible health plan enrolled in by such eligible in-
sured through an Exchange established under 
the Patient Protection and Affordable Care Act. 
‘‘(B) ELIGIBLE INSURED.—The term ‘eli-
gible insured’ has the meaning given such term 
in section 1402(b) of the Patient Protection 
and Affordable Care Act. 
‘‘(C) COORDINATION WITH CONTRIBUTION 
LIMITS; ETC.—The payments described in para-
graph (1)(B) shall not fail to be taken into ac-
count under this section as contributions to the 
health savings account to which paid and such 
payments shall not be required to be made to 
the extent that the eligible insured does not 
have a health savings account or such account 
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is prohibited from accepting such payment by 
reason of subsection (d)(1)(A)(ii).’’. 
(b) REQUIREMENTS RELATED TO EXCHANGE-PRO-
VIDED HIGH DEDUCTIBLE HEALTH PLANS.—Section 
1301(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18021(a)) is amended by adding at the end 
the following new paragraph: 
‘‘(5) REQUIREMENTS RELATED TO HIGH DE-
DUCTIBLE HEALTH PLANS.— 
‘‘(A) REQUIREMENT TO OFFER HIGH DE-
DUCTIBLE HEALTH PLAN AS ALTERNATIVE.—A 
health plan in the silver level of coverage in the 
individual market which is not a high deductible 
health plan shall not be treated as a qualified 
health plan unless the health insurance issuer 
offering such plan offers a high deductible 
health plan which is actuarially equivalent to 
such plan to any individual who would be an eli-
gible insured (as defined in section 1402(b)) if 
such individual were enrolled in such plan. 
‘‘(B) REQUIREMENT
TO
MAKE
HEALTH 
SAVINGS ACCOUNT CONTRIBUTIONS UPON ELEC-
TION OF ELIGIBLE INSURED.—A high deduct-
ible health plan shall not be treated as a quali-
fied health plan unless the health insurance 
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issuer offering such plan complies with the re-
quirement of section 223(i)(1)(B) of such Code 
with respect to such plan. 
‘‘(C) 
DETERMINATION
OF
ACTUARIAL 
VALUE.—For purposes of this Act, the actuarial 
value of a high deductible health plan shall take 
into account payments made by the issuer to a 
health savings account of the enrollee pursuant 
to such plan. 
‘‘(D) HIGH DEDUCTIBLE HEALTH PLAN.— 
For purposes of this paragraph, the term ‘high 
deductible health plan’ has the meaning given 
such term by section 223 of the Internal Rev-
enue Code of 1986.’’. 
(c) PUBLIC EDUCATION.—Beginning on January 1, 
2026, each health insurance issuer offering coverage 
through an Exchange established under the Patient Pro-
tection and Affordable Care Act, and each such Exchange, 
shall provide all prospective enrollees— 
(1) information regarding the availability of in-
surer-provided health savings account contributions 
in lieu of reduced cost-sharing for silver level high 
deductible health plans selected in the Exchange, 
and 
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(2) information regarding how to establish and 
use a health savings account. 
(d) PERMANENT APPROPRIATION FOR COST-SHAR-
ING REDUCTION PAYMENTS AND HSA CONTRIBUTIONS 
MADE IN LIEU OF SUCH PAYMENTS.—Necessary amounts 
are appropriated to the Secretary of the Treasury for 
making payments described in section 1402(d)(3) of the 
Patient Protection and Affordable Care Act, and pay-
ments described in section 223(i)(1)(C) of the Internal 
Revenue Code of 1986 (as added by this section), for 
months beginning after December 31, 2025. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 31, 2025. 
Æ 
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