[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4651 Introduced in House (IH)]
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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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``American Future Healthcare Act of
2019''.
SEC. 2. REFORM OF HEALTH SAVINGS ACCOUNTS.
(a) Repeal of High Deductible Health Plan Requirement.--Section
223(a) of the Internal Revenue Code of 1986 is amended to read as
follows:
``(a) Deduction Allowed.--In the case of an individual, there shall
be allowed as a deduction for a taxable year an amount equal to the
aggregate amount paid in cash during such taxable year by or on behalf
of such individual to a health savings account of such individual.''.
(b) Increase in Deductible HSA Contribution Limitations.--Section
223(b)(1) of such Code is amended by striking ``the sum of the
monthly'' and all that follows through ``eligible individual'' and
inserting ``$10,000 ($20,000 in the case of a joint return)''.
(c) Medicare Eligible Individuals Eligible To Contribute to HSA.--
Section 223(b) of such Code is amended by striking paragraph (7).
(d) Purchase of Health Insurance.--Section 223(d)(2) of such Code
is amended--
(1) by striking subparagraphs (B) and (C), and
(2) by striking ``Qualified medical expenses.--'' and all
that follows through ``The term'' and inserting ``Qualified
medical expenses.--The term''.
(e) Cost-of-Living Adjustment for Catchup Contributions.--Section
223(f)(1) of such Code (as redesignated by subsection (g)(3)) is
amended by striking ``Each dollar amount in subsections (b)(2) and
(c)(2)(A)'' and inserting ``In the case of a taxable year beginning
after December 31, 2019, each dollar amount in paragraphs (1) and (2)
of subsection (b)''.
(f) Cost-of-Living Adjustment Indexed to CPI Medical Care
Component.--Section 223(f) (as so redesignated) is amended by adding at
the end the following new paragraph:
``(3) CPI medical care component.--
``(A) In general.--For purposes of paragraph (1),
the cost-of-living adjustment determined under section
1(f)(3) for the calendar year shall be determined by
substituting `CPI medical care component' for `CPI'.
``(B) CPI medical care component.--For purposes of
subparagraph (A), the term `CPI medical care component'
means the medical care component for the Consumer Price
Index for All Urban Consumers published by the
Department of Labor.''.
(g) Conforming Amendments.--
(1) Section 223(b) of such Code is amended by striking
paragraphs (2), (5), and (8) and by redesignating paragraphs
(3), (4), and (6) as paragraphs (2), (3), and (4),
respectively.
(2) Section 223(b)(3) of such Code (as redesignated by
paragraph (1)) is amended by striking the last sentence.
(3) Section 223 of such Code is amended by striking
subsection (c) and redesignating subsections (d) through (h) as
subsections (c) through (g), respectively.
(4) Section 223(c)(1)(A) of such Code (as redesignated by
paragraph (3)) is amended--
(A) by striking ``subsection (f)(5)'' and inserting
``subsection (e)(5)''; and
(B) in clause (ii) by striking ``the sum of--'' and
all that follows and inserting ``the dollar amount in
effect under subsection (b)(1).''.
(5) Section 223(f)(1) (as redesignated by paragraph (3)) is
amended by striking ``calendar year 2003'' and inserting
``calendar year 2014''.
(6) Section 26(b)(2)(U) of such Code is amended by striking
``section 223(f)(4)'' and inserting ``section 223(e)(4)''.
(7) Sections 35(g)(3), 220(f)(5)(A), 848(e)(1)(v),
4973(a)(5), and 6051(a)(12) of such Code are each amended by
striking ``section 223(d)'' each place it appears and inserting
``section 223(c)''.
(8) Section 106(d)(1) of such Code is amended--
(A) by striking ``who is an eligible individual (as
defined in section 223(c)(1))''; and
(B) by striking ``section 223(d)'' and inserting
``section 223(c)''.
(9) Section 408(d)(9) of such Code is amended--
(A) in subparagraph (A) by striking ``who is an
eligible individual (as defined in section 223(c))
and''; and
(B) in subparagraph (C) by striking ``computed on
the basis of the type of coverage under the high
deductible health plan covering the individual at the
time of the qualified HSA funding distribution''.
(10) Section 877A(g)(6) of such Code is amended by striking
``223(f)(4)'' and inserting ``223(e)(4)''.
(11) Section 4973(g) of such Code is amended--
(A) by striking ``section 223(d)'' and inserting
``section 223(c)'';
(B) in paragraph (2), by striking ``section
223(f)(2)'' and inserting ``section 223(e)(2)''; and
(C) by striking ``section 223(f)(3)'' and inserting
``section 223(e)(3)''.
(12) Section 4975 of such Code is amended--
(A) in subsection (c)(6)--
(i) by striking ``section 223(d)'' and
inserting ``section 223(c)''; and
(ii) by striking ``section 223(e)(2)'' and
inserting ``section 223(d)(2)''; and
(B) in subsection (e)(1)(E), by striking ``section
223(d)'' and inserting ``section 223(c)''.
(13) Section 6693(a)(2)(C) of such Code is amended by
striking ``section 223(h)'' and inserting ``section 223(g)''.
(h) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2018.
SEC. 3. HSA ROLLOVER TO MEDICARE ADVANTAGE MSA.
(a) In General.--Section 138(b)(2) of the Internal Revenue Code of
1986 is amended by striking ``or'' at the end of subparagraph (A), by
adding ``or'' at the end of subparagraph (C), and by adding at the end
the following new subparagraph:
``(C) an HSA rollover contribution described in
subsection (d)(5),''.
(b) HSA Rollover Contribution.--Section 138(c) of such Code is
amended by adding at the end the following new paragraph:
``(5) Rollover contribution.--An amount is described in
this paragraph as a rollover contribution if it meets the
requirement of subparagraphs (A) and (B).
``(A) In general.--The requirements of this
subparagraph are met in the case of an amount paid or
distributed from a health savings to the account
beneficiary to the extent the amount is received is
paid into a Medicare Advantage MSA of such beneficiary
not later than the 60th day after the day on which the
beneficiary receives the payment or distribution.
``(B) Limitation.--This paragraph shall not apply
to any amount described in subparagraph (A) received by
an individual from a health savings account if, at any
time during the 1-year period ending on the day of such
receipt, such individual received any other amount
described in subparagraph (A) from a health savings
account which was not includible in the individual's
gross income because of the application of section
223(e)(5)(A).''.
(c) Conforming Amendment.--Section 223(e)(5)(A) of such Code, as
amended by section 2, is amended by inserting ``or Medicare Advantage
MSA'' after ``into a health savings account''.
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2018.
SEC. 4. TREATMENT OF DIRECT PRIMARY CARE SERVICE ARRANGEMENT FEES AS
MEDICAL EXPENSE.
(a) In General.--Section 223(c)(2)(C) of the Internal Revenue Code
of 1986, as amended by the preceding provisions of this Act, is amended
by striking ``or'' at the end of clause (iii), by striking the period
at the end of clause (iv) and inserting ``, or'', and by adding at the
end the following new clause:
``(v) any direct primary care service arrangement.''.
(b) Direct Primary Care Service Arrangement.--Section 223(c) of
such Code, as amended by the preceding provisions of this Act, is
amended by redesignating paragraph (4) as paragraph (5) and by
inserting after paragraph (3) the following new paragraph:
``(4) Direct primary care service arrangement.--For
purposes of this paragraph--
``(A) In general.--The term `direct primary care
service arrangement' means, with respect to any
individual, an arrangement under which such individual
is provided medical care (as defined in section 213(d))
consisting solely of primary care services (as defined
in section 1833(x)(2)(B) of the Social Security Act)
provided by primary care practitioners (as defined in
section 1833(x)(2)(A) of the Social Security Act,
determined without regard to clause (ii) thereof), if
the sole compensation for such care is a fixed periodic
fee.
``(B) Limitation.--With respect to any individual
for any month, such term shall not include any
arrangement if the aggregate fees for all direct
primary care service arrangements (determined without
regard to this subclause) with respect to such
individual for such month exceed $150 (twice such
dollar amount in the case of an individual with any
direct primary care service arrangement (as so
determined) that covers more than one individual).
``(C) Certain services specifically excluded from
treatment as primary care services.--For purposes of
this paragraph, the term `primary care services' shall
not include--
``(i) procedures that require the use of
general anesthesia,
``(ii) prescription drugs (other than
vaccines), and
``(iii) laboratory services not typically
administered in an ambulatory primary care
setting.
The Secretary, after consultation with the Secretary of
Health and Human Services, shall issue regulations or
other guidance regarding the application of this
subparagraph.''.
(c) Inflation Adjustment.--Section 223(g)(1) of such Code is
amended--
(1) by striking ``and (c)(2)(A)'' and inserting ``,
(c)(2)(A), and (c)(4)(B)'', and
(2) in subparagraph (B), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'' in clause (i), by striking
``and'' at the end of clause (i), by striking the period at the
end of clause (ii) and inserting ``, and'', and by inserting
after clause (ii) the following new clause:
``(iii) in the case of the dollar amount in
subsection (c)(4)(B) for taxable years
beginning in calendar years after 2019,
`calendar year 2018'.''.
(d) Reporting of Direct Primary Care Service Arrangement Fees on W-
2.--Section 6051(a) of such Code is amended by striking ``and'' at the
end of paragraph (16), by striking the period at the end of paragraph
(17) and inserting ``, and'', and by inserting after paragraph (17) the
following new paragraph:
``(18) in the case of a direct primary care service
arrangement (as defined in section 223(c)(4)) which is provided
in connection with employment, the aggregate fees for such
arrangement for such employee.''.
(e) Effective Date.--The amendments made by this subsection shall
apply to months beginning after December 31, 2018, in taxable years
ending after such date.
SEC. 5. ALLOWING CERTAIN INDIVIDUALS WITH ALTERNATIVE HEALTH COVERAGE
TO CHOOSE TO OPT OUT OF THE MEDICARE PART A BENEFIT.
(a) In General.--Any individual described in subsection (c) who is
otherwise entitled to benefits under part A of title XVIII of the
Social Security Act may elect (in such form and manner as may be
specified by the Commissioner of Social Security, in consultation with
the Secretary of Health and Human Services) to opt out of such
entitlement. Notwithstanding any other provision of law, in the case of
an individual who makes such an election, such individual--
(1) may (in such form and manner as may be specified by the
Commissioner, in consultation with the Secretary) subsequently
choose to end such election and opt back into such entitlement
(in accordance with a process determined by the Commissioner,
in consultation with the Secretary) without, subject to
subsection (b), being subject to any penalty;
(2) shall not be required to opt out of benefits under
title II of such Act as a condition for making such election;
and
(3) shall not be required to repay any amount paid under
such part A for items and services furnished prior to making
such election.
(b) Notification of Termination of Qualifying Alternative Health
Coverage Required.--
(1) Notification.--In the case of an individual who makes
an election under subsection (a) and whose enrollment in
qualifying alternative health coverage is subsequently
terminated, such individual shall notify the Secretary of
Health and Human Services of such termination not later than 60
days after the date of such termination.
(2) Late enrollment penalty.--If an individual required to
notify the Secretary under paragraph (1) fails to provide such
notification within the period specified under such paragraph
and subsequently chooses to end the election made by such
individual under subsection (a) and opt back into benefits
under part A of title XVIII of the Social Security Act, such
individual shall be subject to a late enrollment penalty (as
determined by the Secretary) in a manner and amount similar to
an individual enrolled under such part A pursuant to section
1818 of such Act (42 U.S.C. 1395i-2).
(c) Individual Described.--
(1) In general.--For purposes of this section, an
individual described in this subsection is an individual who
demonstrates (in accordance with a process determined by the
Commissioner, in consultation with the Secretary) that the
individual is enrolled under qualifying alternative health
coverage.
(2) Qualifying alternative health coverage.--For purposes
of this section, the term ``qualifying alternative health
coverage'' includes a group health plan or health insurance
coverage offered in the group or individual market (as such
terms are defined in section 2791 of the Public Health Service
Act (42 U.S.C. 300gg-91), or other health coverage specified by
the Commissioner, in consultation with the Secretary, that
provides at least benefits comparable to benefits provided
under part A of title XVIII of the Social Security Act.
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