[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5608 Introduced in House (IH)]

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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.

    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 ``Affordable Care and Comprehensive 
Economic Support through Savings Act'' or the ``ACCESS Act''.

SEC. 2. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS IN LIEU OF REDUCED COST-
              SHARING.

    (a) In General.--Section 223 of the Internal Revenue 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-Provided 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 Secretary may provide) the application of this 
        subsection--
                    ``(A) section 1402 of the Patient Protection 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 are equal to 
                the payments made by such issuer under subparagraph 
                (B).
            ``(2) Annual reduced cost-sharing actuarial equivalent 
        amount.--For purposes of this section, the term `annual reduced 
        cost-sharing actuarial equivalent amount' means, with respect 
        to any Exchange-provided high deductible health plan enrolled 
        in by an eligible insured, an amount that would produce an 
        actuarial value equal to the actuarial value of the reduction 
        in cost-sharing (as determined under section 1402 of the 
        Patient Protection and Affordable Care Act and without regard 
        to any election under this subsection) for the plan year 
        determined by taking into account the household income of the 
        eligible insured.
            ``(3) Restriction on distributions.--
                    ``(A) In general.--Any trust which receives 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 during which such a payment is 
                received, no distribution may be made from such trust 
                unless such distribution is made to satisfy a charge 
                properly made to a qualified medical debit card.
                    ``(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 medical 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 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 deductible health 
                plan.--The term `Exchange-provided high deductible 
                health plan' means, with respect to any eligible 
                insured, any high deductible health plan enrolled in by 
                such eligible insured through an Exchange established 
                under the Patient Protection and Affordable Care Act.
                    ``(B) Eligible insured.--The term `eligible 
                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 paragraph (1)(B) shall not 
                fail to be taken into account 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 is prohibited 
                from accepting such payment by reason of subsection 
                (d)(1)(A)(ii).''.
    (b) Requirements Related to Exchange-Provided 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 deductible health 
        plans.--
                    ``(A) Requirement to offer high deductible 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 eligible insured 
                (as defined in section 1402(b)) if such individual were 
                enrolled in such plan.
                    ``(B) Requirement to make health savings account 
                contributions upon election of eligible insured.--A 
                high deductible health plan shall not be treated as a 
                qualified health plan unless the health insurance 
                issuer offering such plan complies with the requirement 
                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 Revenue Code of 1986.''.
    (c) Public Education.--Beginning on January 1, 2025, each health 
insurance issuer offering coverage through an Exchange established 
under the Patient Protection and Affordable Care Act, and each such 
Exchange, shall provide all prospective enrollees--
            (1) information regarding the availability of insurer-
        provided health savings account contributions in lieu of 
        reduced cost-sharing for silver level high deductible health 
        plans selected in the Exchange, and
            (2) information regarding how to establish and use a health 
        savings account.
    (d) Permanent Appropriation for Cost-Sharing 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 payments 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, 2024.
    (e) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2024.
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