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 trans-
parency, 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 Com-
mittee on Ways and Means, and in addition to the Committees on Energy 
and Commerce and the Judiciary, for a period to be subsequently deter-
mined 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 pay-
ments for a health savings account and for a high de-
ductible 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 re-
quire immigrants to have a health savings account and 
high deductible health coverage at time of admission. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Patient-Controlled Healthcare Protection Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
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. 
TITLE I—HEALTH SAVINGS 
ACCOUNT REFORM 
SEC. 101. ADVANTAGE HSA. 
(a) IN GENERAL.—Part III of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 is amended 
by inserting after section 138 the following new section: 
‘‘SEC. 138A. ADVANTAGE HSA. 
‘‘(a) IN GENERAL.—Gross income shall not include 
any payment to the Advantage HSA of an individual by 
the Secretary of the Treasury under section 103 of Pa-
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tient-Controlled Healthcare Protection Act of 2009 or any 
premium payment under such section for the high deduct-
ible health plan with respect to which such Advantage 
HSA relates. 
‘‘(b) ADVANTAGE HSA.—For purposes of this sec-
tion, the term ‘Advantage HSA’ means a health savings 
account (as defined in section 223(d))— 
‘‘(1) which is designated as an Advantage HSA, 
‘‘(2) with respect to which no contribution may 
be made other than— 
‘‘(A) a contribution described in subsection 
(a), 
‘‘(B) a contribution in cash without limita-
tion as to amount, or 
‘‘(C) a trustee-to-trustee transfer described 
in subsection (d), and 
‘‘(3) the governing instrument of which pro-
vides that trustee-to-trustee transfers described in 
subsection (d) may be made to and from such ac-
count. 
‘‘(c) TEN PERCENT BONUS DISTRIBUTION.— 
‘‘(1) IN GENERAL.—Section 223(f)(2) shall not 
apply to any bonus distribution from a health sav-
ings account. 
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‘‘(2) DISTRIBUTIONS.—An eligible Advantage 
HSA participant may receive 10 percent of excess 
funds that have been contributed to the individual or 
household HSA over the deductible in a calendar 
year. The funds will be directly deposited into the 
desired account of the participant. 
‘‘(3) BONUS DISTRIBUTION.—For purposes of 
this subsection, the term ‘bonus distribution’ means 
any distribution which is made during the 30-day 
period beginning on the first day of the calendar 
year to the extent such distribution does not exceed 
an amount equal to the excess (if any) of— 
‘‘(A) the fair market value of the assets in 
such health savings account as of the close of 
the preceding calendar year, over 
‘‘(B) the sum of the annual deductible re-
quired to be paid under the plan for covered 
benefits for the calendar year. 
‘‘(d) STATE CERTIFICATION FOR HIGH DEDUCTIBLE 
HEALTH PLANS.—For purposes of this section— 
‘‘(1) IN
GENERAL.—For purposes of deter-
mining whether or not an individual is an eligible in-
dividual, a health plan shall not be treated as a high 
deductible health plan (as defined under section 
223(c)(2)) unless such plan is certified by the State 
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(1) IN GENERAL.—Subparagraph (A) of section 
223(f)(5) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘a health savings account for 
the benefit of such beneficiary’’ and inserting ‘‘any 
health savings account’’. 
(2) LIMITATION.—Subparagraph (B) of section 
223(f)(5) of such Code is amended— 
(A) by striking ‘‘LIMITATION.—This para-
graph’’ and inserting the following: 
‘‘(B) LIMITATIONS.— 
‘‘(i) IN GENERAL.—This paragraph’’, 
and 
(B) by adding at the end of subparagraph 
(B), as so amended, the following new clause: 
‘‘(ii) TRANSFERS TO OTHER ACCOUNT 
BENEFICIARIES.—This paragraph shall not 
apply to any amount described in subpara-
graph (A) to the extent that immediately 
after such distribution the fair market 
value of the account is less than the an-
nual deductible required to be paid under 
the plan for the calendar year within which 
the distribution is made.’’. 
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(b) MIGRANT WORKER HSA.—Section 223 of such 
Code is amended by adding at the end the following new 
subsection: 
‘‘(i) MIGRANT WORKER HSA.— 
‘‘(1) IN GENERAL.—An employer may establish 
for the benefit of any eligible employee a health sav-
ings account. 
‘‘(2) ELIGIBLE
EMPLOYEE.—For purposes of 
this subsection, the term ‘eligible employee’ means 
any individual (other than a citizen or resident of 
the United States)— 
‘‘(A) with respect to whom the employee 
provides remuneration for employment, and 
‘‘(B) who is lawfully present in the United 
States and has been granted authorization to 
engage in employment in the United States.’’. 
(c) OTHER REFORMS.—Section 223 of such Code is 
amended as follows: 
(1) By striking paragraphs (1) through (4) and 
(6) through (8) of subsection (b) and by redesig-
nating paragraph (5) as paragraph (1). 
(2) By inserting after paragraph (1), as so re-
designated, the following new paragraph: 
‘‘(2) HOUSEHOLD HSA.—In the case of health 
savings accounts with respect to which individuals 
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who are members of the same household are the ac-
count beneficiaries, upon filing the return of tax for 
any taxable year, each such individual shall include 
on the return each social security number of all par-
ticipating members of such individual’s household.’’. 
(3) By amending paragraph (1) of subsection 
(c) to read as follows: 
‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means any individual.’’. 
(4) By amending subsection (c)(2)(A) to read 
as follows: 
‘‘(A) IN
GENERAL.—The term ‘high de-
ductible health plan’ means a health plan which 
has an annual deductible which is not less 
than— 
‘‘(i) $2,500 for self-only coverage, and 
‘‘(ii) $3,500 for family or household 
coverage.’’. 
(5) By striking subparagraph (B) of subsection 
(c)(2) and redesignating subparagraphs (C) and (D) 
thereof as subparagraphs (B) and (C), respectively. 
(6) By adding at the end of subsection (c)(2), 
as so amended, the following new subparagraph: 
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‘‘(D) OTHER REQUIREMENTS.—An Advan-
tage HSA plan will offer the following to the in-
dividual or household participants— 
‘‘(i) the plan shall not require that an 
individual see a general physician prior to 
a seeing specialist, and 
‘‘(ii) coverage may not be denied 
based on a pre-existing condition of an in-
dividual.’’. 
(7) By adding at the end of subparagraph (A) 
of subsection (d)(2) the following: ‘‘Such term shall 
include any expense which is on the list of eligible 
healthcare expenses most recently submitted by the 
HSA Healthcare Panel under section 105(b)(2) of 
the Patient-Controlled Healthcare Protection Act of 
2009.’’. 
(8) By striking ‘‘the individual’’ in subsection 
(d)(3) and inserting ‘‘an individual’’. 
(9) By adding at the end of subsection (e) the 
following new paragraph: 
‘‘(3) EXCEPTION.—In the case of a termination 
occurring after the date of the enactment of the Pa-
tient-Controlled Healthcare Protection Act of 2009, 
in lieu of being treated as a distribution not used to 
pay qualified medical expenses, such amounts shall 
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be transferred by the account beneficiaries to an-
other health savings account.’’. 
(10) In subsection (f), by striking paragraphs 
(2), (3), (5), and (8) of and redesignating para-
graphs (4), (6), and (7) as paragraphs (2), (3), and 
(4), respectively. 
(11) By amending paragraph (2) of subsection 
(f), as so redesignated, to read as follows: 
‘‘(2) AMOUNTS NOT USED FOR QUALIFIED MED-
ICAL EXPENSES.—Any amount paid or distributed 
out of a health savings account which is not used ex-
clusively to pay the qualified medical expenses of an 
account beneficiary shall be recontributed by the 
beneficiary to such health savings account.’’. 
(12) By adding at the end (as amended by this 
Act) the following new subsection: 
‘‘(j) OTHER SPECIAL RULES.—For purposes of this 
section— 
‘‘(1) INVESTMENT
OF
HSA
FUNDS.—Account 
beneficiaries may invest any amount in their health 
savings account in excess of their deductible in infla-
tion-proof United States bonds. 
‘‘(2) TERMINATION OF HOUSEHOLD.—Any ac-
count beneficiaries of a household HSA shall sign an 
agreement as to distribution of amounts from such 
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HSA prior to termination of the HSA, which will be 
kept on file with the entity in which the HSA funds 
are being held. 
‘‘(3) PORTABILITY.—An individual or household 
participant owns their HSA and insurance policy (if 
they choose to have one) and therefore the policies 
are portable.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2009. 
SEC. 103. ADVANTAGE HSA PAYMENT PROGRAM. 
(a) IN GENERAL.—The Advantage HSA payment 
program provided under this section shall be in lieu of en-
titlement to, and eligibility for, benefits and assistance de-
scribed in subsection (d)(2). Effective on the date the Ad-
vantage HSA payment program is established, titles 
XVIII, XIX, and XXI of the Social Security Act are re-
pealed, except for purposes of determining whether an in-
dividual is an Advantage eligible individual under this sec-
tion. 
(b) HSA CONTRIBUTIONS.—In the case of an indi-
vidual or household who is eligible for an Advantage HSA, 
the Secretary of Treasury, in consultation with the Sec-
retary of Health and Human Services, shall pay an annual 
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(2) ADVANTAGE ELIGIBLE.—The term ‘‘Advan-
tage eligible’’ means, with respect to any month— 
(A) entitled, as of the 1st day of such 
month, to benefits under part A of title XVIII 
of the Social Security Act or to enroll under 
part B of such title, or 
(B) eligible, as of the 1st day of such 
month, for medical or child health assistance 
under title XIX or XXI of such Act (other than 
under section 1928 of such Act). 
(e) APPLICABLE ANNUAL AMOUNT.—For purposes of 
this section— 
(1) IN GENERAL.—The term ‘‘applicable annual 
amount’’ means $2,500. 
(2) ADDITIONAL AMOUNT.—In the case of an 
Advantage HSA eligible household, $3,500. 
(f) DEFINITIONS.—Except as otherwise provided, 
terms used in this section shall have the same respective 
meanings as when used in sections 138A and 223 of the 
Internal Revenue Code of 1986. 
(g) REGULATIONS.—The Secretary of the Treasury 
shall prescribe such regulations as may be necessary or 
appropriate to carry out the purposes of this section, in-
cluding regulations providing for the following: 
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(1) Recapture of amounts paid under sub-
section (a) (and any earnings attributable thereto) 
which are distributed out of an Advantage HSA and 
not used exclusively to pay qualified medical ex-
penses of the account beneficiary. 
(2) Ensuring that not more than the applicable 
annual amount under paragraph (1) of subsection 
(d) (and any additional amount under paragraph (2) 
of such subsection) shall be paid with respect to any 
individual, the spouse of such individual, and all de-
pendents with respect to such individual. 
(3) Ensuring that all individuals with respect to 
whom an election has been made under this section 
are covered under the high deductible plan to which 
the applicable Advantage HSA relates. 
SEC. 104. HEALTH SAVINGS ACCOUNT DEBIT CARD. 
(a) IN GENERAL.—The Secretary of the Treasury, in 
consultation with the Secretary of Health and Human 
Services, shall establish a program under which trustees 
of health savings accounts can issue debit cards with 
which account beneficiaries may pay for qualified medical 
expenses (as defined in section 223 of the Internal Rev-
enue Code of 1986). Such program shall provide for the 
following: 
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(1) Participation from health care providers 
and vendors of products the purchase of which quali-
fies as a qualified medical expense (as so defined). 
(2) A uniform coding system implemented by 
such providers and vendors such that such debit 
cards may not be used to purchase services or prod-
ucts which are not qualified medical expenses (as so 
defined). 
(3) That prior to payment with such card such 
providers and vendors require presentation an identi-
fication card that matches the individual identified 
on the debit card and provides a photograph and is 
issued by a State or the Federal Government, or a 
document that, with respect to identification of the 
individual identified on the debit card, is considered 
acceptable 
for 
purposes 
of 
sections 
274a.2(b)(1)(v)(A) and 274a.2(b)(1)(v)(B) of title 8, 
Code of Federal Regulations (as in effect on or after 
the date of the enactment of this Act). 
(4) That the individual presenting such debit 
card for payment sign a statement that affirms pay-
ment is for a qualified medical expense with respect 
to such individual and which acknowledges that use 
of such debit card for any other expense constitutes 
a false statements or misrepresentations which may 
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subject the purchaser to criminal penalties under 
section 1001 of title 18, United States Code, which 
notice specifies the maximum fine and term of im-
prisonment under such section. 
(b) SUBMISSION OF INFORMATION.—Each trustee of 
a health savings account shall submit to the HSA 
Healthcare Panel (established under section 105) a report 
detailing all purchases made with debit cards from health 
savings accounts of the trustee. Such report shall not con-
tain any personal information of the account beneficiaries 
of such health savings accounts. 
(c) HEALTH SAVINGS ACCOUNT; QUALIFIED MED-
ICAL EXPENSES.—For purposes of this section, the terms 
‘‘health savings account’’ and ‘‘qualified medical ex-
penses’’ shall have the respective meanings given such 
terms by section 223 of the Internal Revenue Code of 
1986. 
SEC. 105. HSA HEALTHCARE PANEL. 
(a) ESTABLISHMENT.—There is established a Panel 
to be known as the ‘‘HSA Healthcare Panel’’ (in this sec-
tion referred to as the ‘‘Panel’’). 
(b) DUTIES.— 
(1) REVIEW
OF
QUALIFIED
MEDICAL
EX-
PENSES.—The Panel shall review the reports and 
other information submitted to the Panel under sec-
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tion 104 or requested by the Panel and review ap-
propriate information regarding the healthcare treat-
ments, services, and products that are potentially 
treatable as qualified medical expenses for purposes 
of section 223 of the Internal Revenue Code of 
1986. 
(2) REPORT.—The Panel shall, not later than 
1 year after the date of enactment of this Act and 
annually thereafter submit a report to Congress pro-
viding a new list of eligible healthcare expenses. 
(c) MEMBERSHIP.— 
(1) IN
GENERAL.—The Panel shall be com-
prised of 101 members. 
(2) APPOINTMENTS.— 
(A) VOTING
MEMBER
AND
CHAIR.—The 
Surgeon General of the United States shall be 
a voting member of the Panel, and shall be the 
chairperson. 
(B) OTHER VOTING MEMBERS.—The Gov-
ernor of each State shall appoint 2 voting mem-
bers to the Panel, one of whom shall be a 
health care specialist and one of whom shall not 
be a health care specialist. 
(3) DATE
OF
APPOINTMENTS.—The appoint-
ment of a members of the Panel shall be made not 
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