[House Report 115-847]
[From the U.S. Government Publishing Office]


115th Congress    }                                     {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                     {     115-847

======================================================================




                THE ``HEALTH CARE SECURITY ACT OF 2018''

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Brady, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6306]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6306) to amend the Internal Revenue Code of 1986 to 
increase the maximum contribution limit to health savings 
accounts to the amount of the deductible and out-of-pocket 
limitation under a high deductible health plan, to permit both 
spouses to make catch-up contributions to the same health 
savings account, and to permit amounts to be paid for qualified 
medical expenses from a health savings account that is 
established during the 60-day period beginning on the date that 
coverage under a high deductible health plan begins, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.


























115th Congress     }                                   {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session        }                                   {      115-847

======================================================================



 
                    HEALTH CARE SECURITY ACT OF 2018

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 6306]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6306) to amend the Internal Revenue Code of 1986 to 
increase the contribution limitation for health savings 
accounts, and for other purposes, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
 I. SUMMARY AND BACKGROUND............................................4
II. EXPLANATION OF THE BILL...........................................5
        A. Maximum Contribution Limit to Health Savings Account 
            Increased to Amount of Deductible and Out-of-Pocket 
            Limitation...........................................     5
        B. Allow Both Spouses to Make Catch-Up Contributions to 
            the Same Health Savings Account......................     7
        C. Special Rule for Certain Medical Expenses Incurred 
            Before Establishment of Health Savings Account.......     8
III.VOTES OF THE COMMITTEE............................................9

IV. BUDGET EFFECTS OF THE BILL.......................................11
        A. Committee Estimate of Budgetary Effects...............    11
        B. Statement Regarding New Budget Authority and Tax 
            Expenditures Budget Authority........................    13
        C. Cost Estimate Prepared by the Congressional Budget 
            Office...............................................    13
 V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......13
        A. Committee Oversight Findings and Recommendations......    13
        B. Statement of General Performance Goals and Objectives.    13
        C. Information Relating to Unfunded Mandates.............    13
        D. Applicability of House Rule XXI 5(b)..................    14
        E. Tax Complexity Analysis...............................    14
        F. Congressional Earmarks, Limited Tax Benefits, and 
            Limited Tariff Benefits..............................    14
        G. Duplication of Federal Programs.......................    14
        H. Disclosure of Directed Rule Makings...................    14
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED............15
        B. Changes in Existing Law Proposed by the Bill, as 
            Reported.............................................    15

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Health Care Security Act of 2018''.

SEC. 2. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS ACCOUNT INCREASED 
                    TO AMOUNT OF DEDUCTIBLE AND OUT-OF-POCKET 
                    LIMITATION.

  (a) Self-Only Coverage.--Section 223(b)(2)(A) of the Internal Revenue 
Code of 1986 is amended by striking ``$2,250'' and inserting ``the 
amount in effect under subsection (c)(2)(A)(ii)(I)''.
  (b) Family Coverage.--Section 223(b)(2)(B) of such Code is amended by 
striking ``$4,500'' and inserting ``the amount in effect under 
subsection (c)(2)(A)(ii)(II)''.
  (c) Conforming Amendments.--Section 223(g)(1) of such Code is 
amended--
          (1) by striking ``subsections (b)(2) and'' both places it 
        appears and inserting ``subsection'', and
          (2) in subparagraph (B), by striking ``determined by'' and 
        all that follows through ```calendar year 2003'.'' and 
        inserting ``determined by substituting `calendar year 2003' for 
        `calendar year 2016' in subparagraph (A)(ii) thereof.''.
  (d) Effective Date.--The amendments made by this section shall apply 
to taxable years beginning after December 31, 2018.

SEC. 3. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO THE SAME 
                    HEALTH SAVINGS ACCOUNT.

  (a) In General.--Section 223(b)(5) of the Internal Revenue Code of 
1986 is amended to read as follows:
          ``(5) Special rule for married individuals with family 
        coverage.--
                  ``(A) In general.--In the case of individuals who are 
                married to each other, if both spouses are eligible 
                individuals and either spouse has family coverage under 
                a high deductible health plan as of the first day of 
                any month--
                          ``(i) the limitation under paragraph (1) 
                        shall be applied by not taking into account any 
                        other high deductible health plan coverage of 
                        either spouse (and if such spouses both have 
                        family coverage under separate high deductible 
                        health plans, only one such coverage shall be 
                        taken into account),
                          ``(ii) such limitation (after application of 
                        clause (i)) shall be reduced by the aggregate 
                        amount paid to Archer MSAs of such spouses for 
                        the taxable year, and
                          ``(iii) such limitation (after application of 
                        clauses (i) and (ii)) shall be divided equally 
                        between such spouses unless they agree on a 
                        different division.
                  ``(B) Treatment of additional contribution amounts.--
                If both spouses referred to in subparagraph (A) have 
                attained age 55 before the close of the taxable year, 
                the limitation referred to in subparagraph (A)(iii) 
                which is subject to division between the spouses shall 
                include the additional contribution amounts determined 
                under paragraph (3) for both spouses. In any other 
                case, any additional contribution amount determined 
                under paragraph (3) shall not be taken into account 
                under subparagraph (A)(iii) and shall not be subject to 
                division between the spouses.''.
  (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2018.

SEC. 4. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE 
                    ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.

  (a) In General.--Section 223(d)(2) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new subparagraph:
                  ``(D) Treatment of certain medical expenses incurred 
                before establishment of account.--If a health savings 
                account is established during the 60-day period 
                beginning on the date that coverage of the account 
                beneficiary under a high deductible health plan begins, 
                then, solely for purposes of determining whether an 
                amount paid is used for a qualified medical expense, 
                such account shall be treated as having been 
                established on the date that such coverage begins.''.
  (b) Effective Date.--The amendment made by this section shall apply 
with respect to coverage beginning after December 31, 2018.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill H.R. 6306, as reported by the Committee on Ways 
and Means expands access and enhances the utility of health 
savings accounts (HSAs) through several common-sense 
improvements to the eligibility, contribution and expenditure 
rules governing HSAs. Specifically, this bill would increase 
the contributions limits for HSAs, permit spousal catch-up 
contributions into the same account and create a grace period 
for medical expenses incurred before the establishment of an 
HSA.

                 B. Background and Need for Legislation

    According to a survey of 52 health insurers conducted by 
America's Health Insurance Plans (AHIP), 21.8 million people 
were covered by a HDHP with an HSA as of January 2017. These 
plans and accounts are an increasingly popular option for 
workers and enrollment growth shows no sign of slowing. A 
survey of employer-sponsored health benefits found that 17 
percent of all employers offered a HDHP with an HSA in 2017 
compared to 2 percent in 2005.
    HSA account holders are diverse. According to WageWorks, 
Inc., the administrator of benefits for more than 7 million 
people, the median household income for an HSA accountholder is 
$57,060. In addition, a JCT analysis found that of the tax 
returns that took an HSA deduction in 2015, 71 percent of the 
returns reported an income of $200,000 or less, and 28 percent 
reported an income of $75,000 or less. Account holders are also 
distributed across age groups, with nearly a third between the 
ages of 25-44 and another third of account holders between the 
ages 45-64.
    Most critically, research has consistently found that such 
coverage, which empowers individuals and families to be more 
engaged health care consumers, is capable of significantly 
reducing health care costs.

                         C. Legislative History


Background

    H.R. 6306 was introduced on July 3, 2018, and was referred 
to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 6306, the 
``Health Care Security Act of 2018,'' on July 12, 2018, and 
ordered the bill, as amended, favorably reported (with a quorum 
being present).

Committee hearings

    The policy issues associated with Health Savings Accounts 
(HSAs) and need for legislative response were discussed at the 
following Ways and Means hearings during the 114th and 115th 
Congress:
           Full Committee Hearing on the Tax Treatment 
        of Health Care (April 14, 2016)
           Subcommittee on Health Member Day Hearing on 
        Tax-Related Proposals to Improve Health Care (May 17, 
        2016)
           Subcommittee on Health Hearing on Rising 
        Health Insurance Premiums Under the Affordable Care Act 
        (July 12, 2016)
           Subcommittee on Health Hearing on Lowering 
        Costs and Expanding Access to Health Care through 
        Consumer-Directed Health Plans (June 6, 2018)

                      II. EXPLANATION OF THE BILL


 A. Maximum Contribution Limit to Health Savings Account Increased to 
           Amount of Deductible and Out-of-Pocket Limitation


                              PRESENT LAW

Health savings accounts

    An individual may establish a health savings account 
(``HSA'') only if the individual is covered under a plan that 
meets the requirements for a high deductible health plan, as 
described below. In general, HSAs provide tax-favored treatment 
for current medical expenses as well as the ability to save on 
a tax-favored basis for future medical expenses. In general, an 
HSA is a tax-exempt trust or custodial account created 
exclusively to pay for the qualified medical expenses of the 
account holder and his or her spouse and dependents.
    Within limits,\1\ contributions to an HSA made by or on 
behalf of an eligible individual are deductible by the 
individual. Contributions to an HSA are excludible from income 
and employment taxes if made by the employer. Earnings in HSAs 
are not taxable. Distributions from an HSA for qualified 
medical expenses are not includible in gross income. 
Distributions from an HSA that are not used for qualified 
medical expenses are includible in gross income and are subject 
to an additional tax of 20 percent. The 20-percent additional 
tax does not apply if the distribution is made after death or 
disability, or after the individual attains the age of Medicare 
eligibility (age 65).
---------------------------------------------------------------------------
    \1\For 2018, the basic limit on annual contributions that can be 
made to an HSA is $3,450 in the case of self-only coverage and $6,900 
in the case of family coverage. (The 2018 limitation for family 
coverage was revised by the IRS to permit taxpayers to disregard the 
$6,850 limitation under the modified inflation adjustment of Pub. L. 
No. 115-97. Rev. Rul. 2018-27, 2018-20 I.R.B. 591, May 14, 2018.) The 
basic annual contributions limits are increased by $1,000 for 
individuals who have attained age 55 by the end of the taxable year 
(referred to as ``catch-up'' contributions).
---------------------------------------------------------------------------

High deductible health plans.

    A high deductible health plan is a health plan that has a 
minimum annual deductible of $1,350 (for 2018) for self-only 
coverage and twice this amount for family coverage, and for 
which the sum of the annual deductible and other annual out-of-
pocket expenses (other than premiums) for covered benefits does 
not exceed $6,650 (for 2018) for self-only coverage and twice 
this amount for family coverage.\2\ These dollar thresholds are 
subject to inflation adjustment, based on chained CPI.\3\
---------------------------------------------------------------------------
    \2\Sec. 223(c)(2).
    \3\Sec. 223(g).
---------------------------------------------------------------------------
    An individual who is covered under a high deductible health 
plan is eligible to establish an HSA, provided that while such 
individual is covered under the high deductible health plan, 
the individual is not covered under any health plan that (1) is 
not a high deductible health plan and (2) provides coverage for 
any benefit (subject to certain exceptions) covered under the 
high deductible health plan.\4\
---------------------------------------------------------------------------
    \4\Sec. 223(c)(1).
---------------------------------------------------------------------------
    Various types of coverage are disregarded for this purpose, 
including coverage of any benefit provided by permitted 
insurance, coverage (whether through insurance or otherwise) 
for accidents, disability, dental care, vision care, or long-
term care, as well as certain limited coverage through health 
flexible savings accounts.\5\ Permitted insurance means 
insurance under which substantially all of the coverage 
provided relates to liabilities incurred under workers' 
compensation laws, tort liabilities, liabilities relating to 
ownership or use of property, or such other similar liabilities 
as specified by the Secretary under regulations. Permitted 
insurance also means insurance for a specified disease or 
illness, and insurance paying a fixed amount per day (or other 
period) of hospitalization.\6\
---------------------------------------------------------------------------
    \5\Sec. 223(c)(1)(B).
    \6\Sec. 223(c)(3).
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes connecting consumers to their health 
care dollars through consumer-directed health plans, including 
high deductible health plans, reduces health care costs. The 
Committee further believes that HSAs are an important tool used 
in conjunction with high deductible health plans to permit 
consumers to set aside funds and provide such consumers the 
choice on how to spend those funds to pay for medical care.
    The Committee believes that raising the basic limit on 
aggregate HSA contributions for a year to equal the maximum of 
the sums of the annual deductible and out-of-pocket expenses 
permitted under a high deductible health plan will expand 
access and enhance the utility of HSAs.

                        EXPLANATION OF PROVISION

    Under the provision, the basic limit on aggregate HSA 
contributions for a year is increased to equal the maximum of 
the sum of the annual deductible and out-of-pocket expenses 
permitted under a high deductible health plan. Thus, for 2018, 
the basic limit is $6,650 in the case of self-only coverage and 
$13,300 in the case of family coverage. As under present law, 
basic contribution limits are increased by $1,000 for an 
eligible individual who has attained age 55 by the end of the 
taxable year. In addition, as under present law, the annual HSA 
contribution limit for an individual is generally the sum of 
the limits determined separately for each month (that is, 1/12 
of the limit for the year, including the catch-up limit, if 
applicable), based on the individual's status and health plan 
coverage as of the first day of the month.

                             EFFECTIVE DATE

    The provision is effective for taxable years beginning 
after December 31, 2018.

B. Allow Both Spouses to Make Catch-Up Contributions to the Same Health 
                            Savings Account


                              PRESENT LAW

    An individual with a high deductible health plan and no 
other health plan (other than a plan that provides certain 
permitted insurance or permitted coverage) may establish an 
HSA. HSA contributions for a year are subject to basic dollar 
limits that are adjusted annually as needed to reflect annual 
cost-of-living increases. The basic contribution limits are 
increased by $1,000 for an eligible individual who has attained 
age 55 by the end of the taxable year (referred to as ``catch-
up contributions''). If eligible individuals are married to 
each other and either spouse has family coverage, both spouses 
are treated as having only family coverage, so that the 
contribution limit for family coverage applies. The 
contribution limit (without regard to any catch-up contribution 
amounts) is divided equally between the spouses unless they 
agree on a different division.
    If both spouses of a married couple are eligible 
individuals, each may contribute to an HSA, but they cannot 
have a joint HSA.\7\ Under the rule described above, however, 
the spouses may divide their basic contribution limit for the 
year by allocating the entire amount to one spouse to be 
contributed to that spouse's HSA.\8\
---------------------------------------------------------------------------
    \7\Notice 2004-50, 2004-2 C.B. 196, Q&A-63.
    \8\Notice 2004-50, Q&A-32. Funds from that HSA can be used to pay 
qualified medical expenses for either spouse on a tax-free basis. 
Notice 2004-50, Q&A-36.
---------------------------------------------------------------------------
    This allocation rule does not apply to catch-up 
contribution amounts, however. Thus, if both spouses are at 
least age 55 and eligible to make catch-up contributions, each 
must make the catch-up contribution to his or her own HSA.\9\
---------------------------------------------------------------------------
    \9\Notice 2008-59, 2008-2 C.B. 123, Q&A-22.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes connecting consumers to their health 
care dollars through consumer-directed health plans, including 
high deductible health plans, reduces health care costs. The 
Committee further believes that HSAs are an important tool used 
in conjunction with high deductible health plans to permit 
consumers to set aside funds and provide such consumers the 
choice on how to spend those funds to pay for medical care.
    The Committee believes that allowing both spouses to make 
catch-up contributions to the same health savings account will 
enhance a couple's ability to save and plan for future health 
care expenses.

                        EXPLANATION OF PROVISION

    Under the provision, if both spouses of a married couple 
are eligible for catch-up contributions and either has family 
coverage under a high deductible health plan as of the first 
day of any month, the annual contribution limit that can be 
allocated between them includes catch-up contribution amounts 
of both spouses. Thus, for example, the spouses can agree that 
their combined basic and catch-up contribution amounts are 
allocated to one spouse to be contributed to that spouse's 
HSA.\10\
---------------------------------------------------------------------------
    \10\1Different allocation rules may apply in certain other cases.
---------------------------------------------------------------------------

                             EFFECTIVE DATE

    The provision is effective for taxable years beginning 
after December 31, 2018.

     C. Special Rule for Certain Medical Expenses Incurred Before 
                Establishment of Health Savings Account


                              PRESENT LAW

    Distributions from an HSA for qualified medical expenses 
are not includible in gross income. Distributions from an HSA 
that are not used for qualified medical expenses are includible 
in gross income and are subject to an additional tax of 20 
percent. The 20-percent additional tax does not apply if the 
distribution is made after death, disability, or after the 
individual attains the age of Medicare eligibility (that is, 
age 65).
    In order for a distribution from an HSA to be excludible as 
a payment for a qualified medical expense, the medical expense 
must be incurred on or after the date that the HSA is 
established.\11\ Thus, a distribution from an HSA is not 
excludible as a payment for a qualified medical expense if the 
medical expense is incurred after a taxpayer enrolls in a high 
deductible health plan but before the taxpayer establishes an 
HSA.
---------------------------------------------------------------------------
    \11\Q&A-26 of Notice 2004-2, 2004-1 C.B. 269.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes connecting consumers to their health 
care dollars through consumer-directed health plans, including 
high deductible health plans, reduces health care costs. The 
Committee further believes that HSAs are an important tool used 
in conjunction with high deductible health plans to permit 
consumers to set aside funds and provide such consumers the 
choice on how to spend those funds to pay for medical care.
    The Committee believes that allowing an HSA to be treated 
as established on the date coverage under a high deductible 
health plan begins will expand access to and enhance the 
utility of HSAs.

                        EXPLANATION OF PROVISION

    Under the provision, if an HSA is established during the 
60-day period beginning on the date that an individual's 
coverage under a high deductible health plan begins, then, 
solely for purposes of determining whether an amount paid is 
used for a qualified medical expense, the HSA is treated as 
having been established on the date coverage under the high 
deductible health plan begins. Thus, if a taxpayer establishes 
an HSA within 60 days of the date that the taxpayer's coverage 
under a high deductible health plan begins, any distribution 
from an HSA used as a payment for a qualified medical expense 
incurred during that 60-day period after the high deductible 
health plan coverage began is excludible from gross income as a 
payment for a qualified medical expense even though the expense 
was incurred before the date that the HSA was established.

                             EFFECTIVE DATE

    The provision is effective with respect to coverage 
beginning after December 31, 2018.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6306, the ``Health Care Security Act of 
2018,'' on July 12, 2018.
    The vote on the amendment offered by Mr. Doggett to the 
amendment in the nature of a substitute offered by Chairman 
Brady to H.R. 6306, which would require that plans covered 
under the underlying bill do not discriminate or increase 
premiums on the basis of pre-existing conditions, was not 
agreed to by a roll call vote of 15 yeas to 23 nays. The vote 
was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................  ........        X   .........  Mr. Neal.........        X   ........  .........
Mr. Johnson....................  ........        X   .........  Mr. Levin........        X   ........  .........
Mr. Nunes......................  ........        X   .........  Mr. Lewis........        X   ........  .........
Mr. Reichert...................  ........        X   .........  Mr. Doggett......        X   ........  .........
Mr. Roskam.....................  ........        X   .........  Mr. Thompson.....        X   ........  .........
Mr. Buchanan...................  ........        X   .........  Mr. Larson.......        X   ........  .........
Mr. Smith (NE).................  ........        X   .........  Mr. Blumenauer...        X   ........  .........
Ms. Jenkins....................  ........        X   .........  Mr. Kind.........        X   ........  .........
Mr. Paulsen....................  ........        X   .........  Mr. Pascrell.....        X   ........  .........
Mr. Marchant...................  ........        X   .........  Mr. Crowley......        X   ........  .........
Ms. Black......................  ........  ........  .........  Mr. Davis........        X   ........  .........
Mr. Reed.......................  ........        X   .........  Ms. Sanchez......        X   ........  .........
Mr. Kelly......................  ........        X   .........  Mr. Higgins......        X   ........  .........
Mr. Renacci....................  ........        X   .........  Ms. Sewell.......  ........  ........  .........
Ms. Noem.......................  ........        X   .........  Ms. DelBene......        X   ........  .........
Mr. Holding....................  ........        X   .........  Ms. Chu..........        X   ........  .........
Mr. Smith (MO).................  ........        X   .........
Mr. Rice.......................  ........        X   .........
Mr. Schweikert.................  ........        X   .........
Ms. Walorski...................  ........        X   .........
Mr. Curbelo....................  ........        X   .........
Mr. Bishop.....................  ........        X   .........
Mr. LaHood.....................  ........        X   .........
Mr. Wenstrup...................  ........        X   .........
----------------------------------------------------------------------------------------------------------------

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6306, ``To amend the Internal Revenue 
Code of 1986 to improve the rules with respect of health 
savings accounts,'' on July 12, 2018.
    The vote on the amendment offered by Ms. Chu to the 
amendment in the nature of a substitute offered by Chairman 
Brady to H.R. 6306, which would allow individuals with Health 
Savings Accounts (HSAs) to temporarily designate immigrant 
children in detention settings or unaccompanied children in the 
custody of the Office of Refugee Resettlement (ORR) as 
dependents for purposes of using HSA funds for their medical 
care, was not agreed to by a roll call vote of 16 yeas to 22 
nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................  ........        X   .........  Mr. Neal.........        X   ........  .........
Mr. Johnson....................  ........        X   .........  Mr. Levin........        X   ........  .........
Mr. Nunes......................  ........        X   .........  Mr. Lewis........        X   ........  .........
Mr. Reichert...................  ........        X   .........  Mr. Doggett......        X   ........  .........
Mr. Roskam.....................  ........        X   .........  Mr. Thompson.....        X   ........  .........
Mr. Buchanan...................  ........        X   .........  Mr. Larson.......        X   ........  .........
Mr. Smith (NE).................  ........        X   .........  Mr. Blumenauer...        X   ........  .........
Ms. Jenkins....................  ........        X   .........  Mr. Kind.........        X   ........  .........
Mr. Paulsen....................  ........        X   .........  Mr. Pascrell.....        X   ........  .........
Mr. Marchant...................  ........        X   .........  Mr. Crowley......        X   ........  .........
Ms. Black......................  ........  ........  .........  Mr. Davis........        X   ........  .........
Mr. Reed.......................  ........        X   .........  Ms. Sanchez......        X   ........  .........
Mr. Kelly......................  ........        X   .........  Mr. Higgins......        X   ........  .........
Mr. Renacci....................  ........        X   .........  Ms. Sewell.......        X   ........  .........
Ms. Noem.......................  ........        X   .........  Ms. DelBene......        X   ........  .........
Mr. Holding....................  ........        X   .........  Ms. Chu..........        X   ........  .........
Mr. Smith (MO).................  ........        X   .........
Mr. Rice.......................  ........        X   .........
Mr. Schweikert.................  ........        X   .........
Ms. Walorski...................  ........        X   .........
Mr. Curbelo....................  ........        X   .........
Mr. Bishop.....................  ........        X   .........
Mr. LaHood.....................  ........        X   .........
Mr. Wenstrup...................  ........        X   .........
----------------------------------------------------------------------------------------------------------------

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6306, ``To amend the Internal Revenue 
Code of 1986 to improve the rules with respect to health 
savings accounts'' on July 12, 2018.
    H.R. 6306 was ordered favorably reported to the House of 
Representatives as amended by an amendment in the nature of a 
substitute offered by Chairman Brady by a roll call vote of 22 
yeas to 16 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................        X   ........  .........  Mr. Neal.........  ........        X   .........
Mr. Johnson....................        X   ........  .........  Mr. Levin........  ........        X   .........
Mr. Nunes......................  ........  ........  .........  Mr. Lewis........  ........        X   .........
Mr. Reichert...................        X   ........  .........  Mr. Doggett......  ........        X   .........
Mr. Roskam.....................        X   ........  .........  Mr. Thompson.....  ........        X   .........
Mr. Buchanan...................        X   ........  .........  Mr. Larson.......  ........        X   .........
Mr. Smith (NE).................        X   ........  .........  Mr. Blumenauer...  ........        X   .........
Ms. Jenkins....................        X   ........  .........  Mr. Kind.........  ........        X   .........
Mr. Paulsen....................        X   ........  .........  Mr. Pascrell.....  ........        X   .........
Mr. Marchant...................        X   ........  .........  Mr. Crowley......  ........        X   .........
Ms. Black......................  ........  ........  .........  Mr. Davis........  ........        X   .........
Mr. Reed.......................        X   ........  .........  Ms. Sanchez......  ........        X   .........
Mr. Kelly......................        X   ........  .........  Mr. Higgins......  ........        X   .........
Mr. Renacci....................        X   ........  .........  Ms. Sewell.......  ........        X   .........
Ms. Noem.......................        X   ........  .........  Ms. DelBene......  ........        X   .........
Mr. Holding....................        X   ........  .........  Ms. Chu..........  ........        X   .........
Mr. Smith (MO).................        X   ........  .........
Mr. Rice.......................        X   ........  .........
Mr. Schweikert.................        X   ........  .........
Ms. Walorski...................        X   ........  .........
Mr. Curbelo....................        X   ........  .........
Mr. Bishop.....................        X   ........  .........
Mr. LaHood.....................        X   ........  .........
Mr. Wenstrup...................        X   ........  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6306, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal fiscal year budget receipts for the period 
2019-2028:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               Fiscal Years  [Millions of Dollars]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                            Item                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Maximum Contribution Limit to Health Savings Account               -626       -957     -1,079     -1,211     -1,351     -1,485     -1,624     -1,885     -2,078     -2,231     -5,223    -14,527
 Increased to Amount of Deductible and Out-of-Pocket
 Limitation\1\..............................................
Allow Both Spouses to Make Catch-Up Contributions to the            -22        -44        -46        -47        -48        -50        -51        -56        -60        -62       -207       -486
 Same Health Savings Account\1\.............................
Special Rule for Certain Medical Expenses Incurred Before            -5        -14        -19        -21        -23        -25        -28        -31        -35        -39        -82       -241
 Establishment of Health Savings Account\1\.................
    Total...................................................       -652     -1,016     -1,144     -1,279     -1,422     -1,561     -1,703     -1,972     -2,173     -2,332     -5,512    -15,254
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details may not add to totals due to rounding.
\1\Estimate includes the following off-budget effects:


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Maximum Contribution Limit to Health Savings Account               -149       -224       -253       -285       -318       -352       -385       -417       -451       -486     -1,230     -3,320
 Increased to Amount of Deductible and Out-of-Pocket
 Limitation.................................................
Allow Both Spouses to Make Catch-Up Contributions to the             -7        -14        -14        -15        -15        -16        -16        -18        -17        -17        -65       -149
 Same Health Savings Account................................
Special Rule for Certain Medical Expenses Incurred Before            -1         -5         -8         -9        -10        -11        -12        -13        -14        -16        -34       -101
 Establishment of Health Savings Account....................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: The gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that the revenue-reducing tax 
provision involves no new tax expenditure.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6138, as 
reported. As of the filing of this report, the Committee had 
not received an estimate prepared by the Congressional Budget 
Office (CBO).

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated into 
the description portions of this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                D. Applicability of House Rule XXI 5(b)

    Rule XXI 5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    Section 4022(b) of the Internal Revenue Service 
Restructuring and Reform Act of 1998 (``IRS Reform Act'') 
requires the staff of the Joint Committee on Taxation (in 
consultation with the Internal Revenue Service and the Treasury 
Department) to provide a tax complexity analysis. The 
complexity analysis is required for all legislation reported by 
the Senate Committee on Finance, the House Committee on Ways 
and Means, or any committee of conference if the legislation 
includes a provision that directly or indirectly amends the 
Internal Revenue Code of 1986 and has widespread applicability 
to individuals or small businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code of 1986 and that have ``widespread applicability'' to 
individuals or small businesses, within the meaning of the 
rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(c)(5) of rule XIII of the Rules 
of the House of Representatives, the Committee states that no 
provision of the bill establishes or reauthorizes: (1) a 
program of the Federal Government known to be duplicative of 
another Federal program, (2) a program included in any report 
from the Government Accountability Office to Congress pursuant 
to section 21 of Public Law 111-139, or (3) a program related 
to a program identified in the most recent Catalog of Federal 
Domestic Assistance, published pursuant to section 6104 of 
title 31, United States Code.

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), 
the following statement is made concerning directed rule 
makings: The Committee advises that the bill requires no 
directed rule makings within the meaning of such section.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED


      B. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986




           *       *       *       *       *       *       *
Subtitle A--Income Taxes

           *       *       *       *       *       *       *


CHAPTER 1--NORMAL TAXES AND SURTAXES

           *       *       *       *       *       *       *


Subchapter B--Computation of Taxable Income

           *       *       *       *       *       *       *


PART VII--ADDITIONAL ITEMIZED DEDUCTIONS FOR INDIVIDUALS

           *       *       *       *       *       *       *



SEC. 223. HEALTH SAVINGS ACCOUNTS.

  (a) Deduction allowed.--In the case of an individual who is 
an eligible individual for any month during the taxable year, 
there shall be allowed as a deduction for the 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) Limitations.--
          (1) In general.--The amount allowable as a deduction 
        under subsection (a) to an individual for the taxable 
        year shall not exceed the sum of the monthly 
        limitations for months during such taxable year that 
        the individual is an eligible individual.
          (2) Monthly limitation.--The monthly limitation for 
        any month is \1/12\ of--
                  (A) in the case of an eligible individual who 
                has self- only coverage under a high deductible 
                health plan as of the first day of such month, 
                [$2,250] the amount in effect under subsection 
                (c)(2)(A)(ii)(I).
                  (B) in the case of an eligible individual who 
                has family coverage under a high deductible 
                health plan as of the first day of such month, 
                [$4,500] the amount in effect under subsection 
                (c)(2)(A)(ii)(II).
          (3) Additional contributions for individuals 55 or 
        older.--
                  (A) In general.--In the case of an individual 
                who has attained age 55 before the close of the 
                taxable year, the applicable limitation under 
                subparagraphs (A) and (B) of paragraph (2) 
                shall be increased by the additional 
                contribution amount.
                  (B) Additional contribution amount.--For 
                purposes of this section, the additional 
                contribution amount is the amount determined in 
                accordance with the following table:


 
------------------------------------------------------------------------
                                     The additional contribution amount
  For taxable years beginning in:                    is:
------------------------------------------------------------------------
2004                                $500
2005                                $600
2006                                $700
2007                                $800
2008                                $900
2009 and thereafter                 $1,000.
------------------------------------------------------------------------

          (4) Coordination with other contributions.--The 
        limitation which would (but for this paragraph) apply 
        under this subsection to an individual for any taxable 
        year shall be reduced (but not below zero) by the sum 
        of--
                  (A) the aggregate amount paid for such 
                taxable year to Archer MSAs of such individual,
                  (B) the aggregate amount contributed to 
                health savings accounts of such individual 
                which is excludable from the taxpayer's gross 
                income for such taxable year under section 
                106(d) (and such amount shall not be allowed as 
                a deduction under subsection (a)), and
                  (C) the aggregate amount contributed to 
                health savings accounts of such individual for 
                such taxable year under section 408(d)(9) (and 
                such amount shall not be allowed as a deduction 
                under subsection (a)).
        Subparagraph (A) shall not apply with respect to any 
        individual to whom paragraph (5) applies.
          [(5) Special rule for married individuals.--In the 
        case of individuals who are married to each other, if 
        either spouse has family coverage--
                  [(A) both spouses shall be treated as having 
                only such family coverage (and if such spouses 
                each have family coverage under different 
                plans, as having the family coverage with the 
                lowest annual deductible), and
                  [(B) the limitation under paragraph (1) 
                (after the application of subparagraph (A) and 
                without regard to any additional contribution 
                amount under paragraph (3))--
                          [(i) shall be reduced by the 
                        aggregate amount paid to Archer MSAs of 
                        such spouses for the taxable year, and
                          [(ii) after such reduction, shall be 
                        divided equally between them unless 
                        they agree on a different division.]
          (5) Special rule for married individuals with family 
        coverage.--
                  (A) In general.--In the case of individuals 
                who are married to each other, if both spouses 
                are eligible individuals and either spouse has 
                family coverage under a high deductible health 
                plan as of the first day of any month--
                          (i) the limitation under paragraph 
                        (1) shall be applied by not taking into 
                        account any other high deductible 
                        health plan coverage of either spouse 
                        (and if such spouses both have family 
                        coverage under separate high deductible 
                        health plans, only one such coverage 
                        shall be taken into account),
                          (ii) such limitation (after 
                        application of clause (i)) shall be 
                        reduced by the aggregate amount paid to 
                        Archer MSAs of such spouses for the 
                        taxable year, and
                          (iii) such limitation (after 
                        application of clauses (i) and (ii)) 
                        shall be divided equally between such 
                        spouses unless they agree on a 
                        different division.
                  (B) Treatment of additional contribution 
                amounts.--If both spouses referred to in 
                subparagraph (A) have attained age 55 before 
                the close of the taxable year, the limitation 
                referred to in subparagraph (A)(iii) which is 
                subject to division between the spouses shall 
                include the additional contribution amounts 
                determined under paragraph (3) for both 
                spouses. In any other case, any additional 
                contribution amount determined under paragraph 
                (3) shall not be taken into account under 
                subparagraph (A)(iii) and shall not be subject 
                to division between the spouses.
          (6) Denial of deduction to dependents.--No deduction 
        shall be allowed under this section to any individual 
        with respect to whom a deduction under section 151 is 
        allowable to another taxpayer for a taxable year 
        beginning in the calendar year in which such 
        individual's taxable year begins.
          (7) Medicare eligible individuals.--The limitation 
        under this subsection for any month with respect to an 
        individual shall be zero for the first month such 
        individual is entitled to benefits under title XVIII of 
        the Social Security Act and for each month thereafter.
          (8) Increase in limit for individuals becoming 
        eligible individuals after the beginning of the year.--
                  (A) In general.--For purposes of computing 
                the limitation under paragraph (1) for any 
                taxable year, an individual who is an eligible 
                individual during the last month of such 
                taxable year shall be treated--
                          (i) as having been an eligible 
                        individual during each of the months in 
                        such taxable year, and
                          (ii) as having been enrolled, during 
                        each of the months such individual is 
                        treated as an eligible individual 
                        solely by reason of clause (i), in the 
                        same high deductible health plan in 
                        which the individual was enrolled for 
                        the last month of such taxable year.
                  (B) Failure to maintain high deductible 
                health plan coverage.--
                          (i) In general.--If, at any time 
                        during the testing period, the 
                        individual is not an eligible 
                        individual, then--
                                  (I) gross income of the 
                                individual for the taxable year 
                                in which occurs the first month 
                                in the testing period for which 
                                such individual is not an 
                                eligible individual is 
                                increased by the aggregate 
                                amount of all contributions to 
                                the health savings account of 
                                the individual which could not 
                                have been made but for 
                                subparagraph (A), and
                                  (II) the tax imposed by this 
                                chapter for any taxable year on 
                                the individual shall be 
                                increased by 10 percent of the 
                                amount of such increase.
                          (ii) Exception for disability or 
                        death.--Subclauses (I) and (II) of 
                        clause (i) shall not apply if the 
                        individual ceased to be an eligible 
                        individual by reason of the death of 
                        the individual or the individual 
                        becoming disabled (within the meaning 
                        of section 72(m)(7)).
                          (iii) Testing period.--The term 
                        ``testing period'' means the period 
                        beginning with the last month of the 
                        taxable year referred to in 
                        subparagraph (A) and ending on the last 
                        day of the 12th month following such 
                        month.
  (c) Definitions and special rules.--For purposes of this 
section--
          (1) Eligible individual.--
                  (A) In general.--The term ``eligible 
                individual'' means, with respect to any month, 
                any individual if--
                          (i) such individual is covered under 
                        a high deductible health plan as of the 
                        1st day of such month, and
                          (ii) such individual is not, while 
                        covered under a high deductible health 
                        plan, covered under any health plan--
                                  (I) which is not a high 
                                deductible health plan, and
                                  (II) which provides coverage 
                                for any benefit which is 
                                covered under the high 
                                deductible health plan.
                  (B) Certain coverage disregarded.--
                Subparagraph (A)(ii) shall be applied without 
                regard to--
                          (i) coverage for any benefit provided 
                        by permitted insurance,
                          (ii) coverage (whether through 
                        insurance or otherwise) for accidents, 
                        disability, dental care, vision care, 
                        or long-term care, and
                          (iii) for taxable years beginning 
                        after December 31, 2006, coverage under 
                        a health flexible spending arrangement 
                        during any period immediately following 
                        the end of a plan year of such 
                        arrangement during which unused 
                        benefits or contributions remaining at 
                        the end of such plan year may be paid 
                        or reimbursed to plan participants for 
                        qualified benefit expenses incurred 
                        during such period if--
                                  (I) the balance in such 
                                arrangement at the end of such 
                                plan year is zero, or
                                  (II) the individual is making 
                                a qualified HSA distribution 
                                (as defined in section 106(e)) 
                                in an amount equal to the 
                                remaining balance in such 
                                arrangement as of the end of 
                                such plan year, in accordance 
                                with rules prescribed by the 
                                Secretary.
                  (C) Special rule for individuals eligible for 
                certain veterans benefits.--An individual shall 
                not fail to be treated as an eligible 
                individual for any period merely because the 
                individual receives hospital care or medical 
                services under any law administered by the 
                Secretary of Veterans Affairs for a service-
                connected disability (within the meaning of 
                section 101(16) of title 38, United States 
                Code).
          (2) High deductible health plan.--
                  (A) In general.--The term ``high deductible 
                health plan'' means a health plan--
                          (i) which has an annual deductible 
                        which is not less than--
                                  (I) $1,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage, and
                          (ii) the sum of the annual deductible 
                        and the other annual out-of-pocket 
                        expenses required to be paid under the 
                        plan (other than for premiums) for 
                        covered benefits does not exceed--
                                  (I) $5,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage.
                  (B) Exclusion of certain plans.--Such term 
                does not include a health plan if substantially 
                all of its coverage is coverage described in 
                paragraph (1)(B).
                  (C) Safe harbor for absence of preventive 
                care deductible.--A plan shall not fail to be 
                treated as a high deductible health plan by 
                reason of failing to have a deductible for 
                preventive care (within the meaning of section 
                1861 of the Social Security Act, except as 
                otherwise provided by the Secretary).
                  (D) Special rules for network plans.--In the 
                case of a plan using a network of providers--
                          (i) Annual out-of-pocket 
                        limitation.--Such plan shall not fail 
                        to be treated as a high deductible 
                        health plan by reason of having an out-
                        of-pocket limitation for services 
                        provided outside of such network which 
                        exceeds the applicable limitation under 
                        subparagraph (A)(ii).
                          (ii) Annual deductible.--Such plan's 
                        annual deductible for services provided 
                        outside of such network shall not be 
                        taken into account for purposes of 
                        subsection (b)(2).
          (3) Permitted insurance.--The term ``permitted 
        insurance'' means--
                  (A) insurance if substantially all of the 
                coverage provided under such insurance relates 
                to--
                          (i) liabilities incurred under 
                        workers' compensation laws,
                          (ii) tort liabilities,
                          (iii) liabilities relating to 
                        ownership or use of property, or
                          (iv) such other similar liabilities 
                        as the Secretary may specify by 
                        regulations,
                  (B) insurance for a specified disease or 
                illness, and
                  (C) insurance paying a fixed amount per day 
                (or other period) of hospitalization.
          (4) Family coverage.--The term ``family coverage'' 
        means any coverage other than self-only coverage.
          (5) Archer MSA.--The term ``Archer MSA'' has the 
        meaning given such term in section 220(d).
  (d) Health savings account.--For purposes of this section--
          (1) In general.--The term ``health savings account'' 
        means a trust created or organized in the United States 
        as a health savings account exclusively for the purpose 
        of paying the qualified medical expenses of the account 
        beneficiary, but only if the written governing 
        instrument creating the trust meets the following 
        requirements:
                  (A) Except in the case of a rollover 
                contribution described in subsection (f)(5) or 
                section 220(f)(5), no contribution will be 
                accepted--
                          (i) unless it is in cash, or
                          (ii) to the extent such contribution, 
                        when added to previous contributions to 
                        the trust for the calendar year, 
                        exceeds the sum of--
                                  (I) the dollar amount in 
                                effect under subsection 
                                (b)(2)(B), and
                                  (II) the dollar amount in 
                                effect under subsection 
                                (b)(3)(B).
                  (B) The trustee is a bank (as defined in 
                section 408(n)), an insurance company (as 
                defined in section 816), or another person who 
                demonstrates to the satisfaction of the 
                Secretary that the manner in which such person 
                will administer the trust will be consistent 
                with the requirements of this section.
                  (C) No part of the trust assets will be 
                invested in life insurance contracts.
                  (D) The assets of the trust will not be 
                commingled with other property except in a 
                common trust fund or common investment fund.
                  (E) The interest of an individual in the 
                balance in his account is nonforfeitable.
          (2) Qualified medical expenses.--
                  (A) In general.--The term ``qualified medical 
                expenses'' means, with respect to an account 
                beneficiary, amounts paid by such beneficiary 
                for medical care (as defined in section 213(d)) 
                for such individual, the spouse of such 
                individual, and any dependent (as defined in 
                section 152, determined without regard to 
                subsections (b)(1), (b)(2), and (d)(1)(B) 
                thereof) of such individual, but only to the 
                extent such amounts are not compensated for by 
                insurance or otherwise. Such term shall include 
                an amount paid for medicine or a drug only if 
                such medicine or drug is a prescribed drug 
                (determined without regard to whether such drug 
                is available without a prescription) or is 
                insulin.
                  (B) Health insurance may not be purchased 
                from account.--Subparagraph (A) shall not apply 
                to any payment for insurance.
                  (C) Exceptions.--Subparagraph (B) shall not 
                apply to any expense for coverage under--
                          (i) a health plan during any period 
                        of continuation coverage required under 
                        any Federal law,
                          (ii) a qualified long-term care 
                        insurance contract (as defined in 
                        section 7702B(b)),
                          (iii) a health plan during a period 
                        in which the individual is receiving 
                        unemployment compensation under any 
                        Federal or State law, or
                          (iv) in the case of an account 
                        beneficiary who has attained the age 
                        specified in section 1811 of the Social 
                        Security Act, any health insurance 
                        other than a medicare supplemental 
                        policy (as defined in section 1882 of 
                        the Social Security Act).
                  (D) Treatment of certain medical expenses 
                incurred before establishment of account.--If a 
                health savings account is established during 
                the 60-day period beginning on the date that 
                coverage of the account beneficiary under a 
                high deductible health plan begins, then, 
                solely for purposes of determining whether an 
                amount paid is used for a qualified medical 
                expense, such account shall be treated as 
                having been established on the date that such 
                coverage begins.
          (3) Account beneficiary.--The term ``account 
        beneficiary'' means the individual on whose behalf the 
        health savings account was established.
          (4) Certain rules to apply.--Rules similar to the 
        following rules shall apply for purposes of this 
        section:
                  (A) Section 219(d)(2) (relating to no 
                deduction for rollovers).
                  (B) Section 219(f)(3) (relating to time when 
                contributions deemed made).
                  (C) Except as provided in section 106(d), 
                section 219(f)(5) (relating to employer 
                payments).
                  (D) Section 408(g) (relating to community 
                property laws).
                  (E) Section 408(h) (relating to custodial 
                accounts).
  (e) Tax treatment of accounts.--
          (1) In general.--A health savings account is exempt 
        from taxation under this subtitle unless such account 
        has ceased to be a health savings account. 
        Notwithstanding the preceding sentence, any such 
        account is subject to the taxes imposed by section 511 
        (relating to imposition of tax on unrelated business 
        income of charitable, etc. organizations).
          (2) Account terminations.--Rules similar to the rules 
        of paragraphs (2) and (4) of section 408(e) shall apply 
        to health savings accounts, and any amount treated as 
        distributed under such rules shall be treated as not 
        used to pay qualified medical expenses.
  (f) Tax treatment of distributions.--
          (1) Amounts used for qualified medical expenses.--Any 
        amount paid or distributed out of a health savings 
        account which is used exclusively to pay qualified 
        medical expenses of any account beneficiary shall not 
        be includible in gross income.
          (2) Inclusion of amounts not used for qualified 
        medical expenses.--Any amount paid or distributed out 
        of a health savings account which is not used 
        exclusively to pay the qualified medical expenses of 
        the account beneficiary shall be included in the gross 
        income of such beneficiary.
          (3) Excess contributions returned before due date of 
        return.--
                  (A) In general.--If any excess contribution 
                is contributed for a taxable year to any health 
                savings account of an individual, paragraph (2) 
                shall not apply to distributions from the 
                health savings accounts of such individual (to 
                the extent such distributions do not exceed the 
                aggregate excess contributions to all such 
                accounts of such individual for such year) if--
                          (i) such distribution is received by 
                        the individual on or before the last 
                        day prescribed by law (including 
                        extensions of time) for filing such 
                        individual's return for such taxable 
                        year, and
                          (ii) such distribution is accompanied 
                        by the amount of net income 
                        attributable to such excess 
                        contribution.
                Any net income described in clause (ii) shall 
                be included in the gross income of the 
                individual for the taxable year in which it is 
                received.
                  (B) Excess contribution.--For purposes of 
                subparagraph (A), the term ``excess 
                contribution'' means any contribution (other 
                than a rollover contribution described in 
                paragraph (5) or section 220(f)(5)) which is 
                neither excludable from gross income under 
                section 106(d) nor deductible under this 
                section.
          (4) Additional tax on distributions not used for 
        qualified medical expenses.--
                  (A) In general.--The tax imposed by this 
                chapter on the account beneficiary for any 
                taxable year in which there is a payment or 
                distribution from a health savings account of 
                such beneficiary which is includible in gross 
                income under paragraph (2) shall be increased 
                by 20 percent of the amount which is so 
                includible.
                  (B) Exception for disability or death.--
                Subparagraph (A) shall not apply if the payment 
                or distribution is made after the account 
                beneficiary becomes disabled within the meaning 
                of section 72(m)(7) or dies.
                  (C) Exception for distributions after 
                medicare eligibility.--Subparagraph (A) shall 
                not apply to any payment or distribution after 
                the date on which the account beneficiary 
                attains the age specified in section 1811 of 
                the Social Security Act.
          (5) Rollover contribution.--An amount is described in 
        this paragraph as a rollover contribution if it meets 
        the requirements of subparagraphs (A) and (B).
                  (A) In general.--Paragraph (2) shall not 
                apply to any amount paid or distributed from a 
                health savings account to the account 
                beneficiary to the extent the amount received 
                is paid into a health savings account for the 
                benefit 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 this paragraph.
          (6) Coordination with medical expense deduction.--For 
        purposes of determining the amount of the deduction 
        under section 213, any payment or distribution out of a 
        health savings account for qualified medical expenses 
        shall not be treated as an expense paid for medical 
        care.
          (7) Transfer of account incident to divorce.--The 
        transfer of an individual's interest in a health 
        savings account to an individual's spouse or former 
        spouse under a divorce or separation instrument 
        described in clause (i) of section 121(d)(3)(C) shall 
        not be considered a taxable transfer made by such 
        individual notwithstanding any other provision of this 
        subtitle, and such interest shall, after such transfer, 
        be treated as a health savings account with respect to 
        which such spouse is the account beneficiary.
          (8) Treatment after death of account beneficiary.--
                  (A) Treatment if designated beneficiary is 
                spouse.--If the account beneficiary's surviving 
                spouse acquires such beneficiary's interest in 
                a health savings account by reason of being the 
                designated beneficiary of such account at the 
                death of the account beneficiary, such health 
                savings account shall be treated as if the 
                spouse were the account beneficiary.
                  (B) Other cases.--
                          (i) In general.--If, by reason of the 
                        death of the account beneficiary, any 
                        person acquires the account 
                        beneficiary's interest in a health 
                        savings account in a case to which 
                        subparagraph (A) does not apply--
                                  (I) such account shall cease 
                                to be a health savings account 
                                as of the date of death, and
                                  (II) an amount equal to the 
                                fair market value of the assets 
                                in such account on such date 
                                shall be includible if such 
                                person is not the estate of 
                                such beneficiary, in such 
                                person's gross income for the 
                                taxable year which includes 
                                such date, or if such person is 
                                the estate of such beneficiary, 
                                in such beneficiary's gross 
                                income for the last taxable 
                                year of such beneficiary.
                          (ii) Special rules.--
                                  (I) Reduction of inclusion 
                                for predeath expenses.--The 
                                amount includible in gross 
                                income under clause (i) by any 
                                person (other than the estate) 
                                shall be reduced by the amount 
                                of qualified medical expenses 
                                which were incurred by the 
                                decedent before the date of the 
                                decedent's death and paid by 
                                such person within 1 year after 
                                such date.
                                  (II) Deduction for estate 
                                taxes.--An appropriate 
                                deduction shall be allowed 
                                under section 691(c) to any 
                                person (other than the decedent 
                                or the decedent's spouse) with 
                                respect to amounts included in 
                                gross income under clause (i) 
                                by such person.
  (g) Cost-of-living adjustment.--
          (1) In general.--Each dollar amount in [subsections 
        (b)(2) and] subsection (c)(2)(A) shall be increased by 
        an amount equal to--
                  (A) such dollar amount, multiplied by
                  (B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in 
                which such taxable year begins [determined by 
                substituting for ``calendar year 2016'' in 
                subparagraph (A)(ii) thereof--]
                          [(i) except as provided in clause 
                        (ii), ``calendar year 1997'', and
                          [(ii) in the case of each dollar 
                        amount in subsection (c)(2)(A), 
                        ``calendar year 2003''.] determined by 
                        substituting ``calendar year 2003'' for 
                        ``calendar year 2016'' in subparagraph 
                        (A)(ii) thereof.
        In the case of adjustments made for any taxable year 
        beginning after 2007, section 1(f)(4) shall be applied 
        for purposes of this paragraph by substituting ``March 
        31'' for ``August 31'', and the Secretary shall publish 
        the adjusted amounts under [subsections (b)(2) and] 
        subsection (c)(2)(A) for taxable years beginning in any 
        calendar year no later than June 1 of the preceding 
        calendar year.
          (2) Rounding.--If any increase under paragraph (1) is 
        not a multiple of $50, such increase shall be rounded 
        to the nearest multiple of $50.
  (h) Reports.--The Secretary may require--
          (1) the trustee of a health savings account to make 
        such reports regarding such account to the Secretary 
        and to the account beneficiary with respect to 
        contributions, distributions, the return of excess 
        contributions, and such other matters as the Secretary 
        determines appropriate, and
          (2) any person who provides an individual with a high 
        deductible health plan to make such reports to the 
        Secretary and to the account beneficiary with respect 
        to such plan as the Secretary determines appropriate.
The reports required by this subsection shall be filed at such 
time and in such manner and furnished to such individuals at 
such time and in such manner as may be required by the 
Secretary.

           *       *       *       *       *       *       *


                            DISSENTING VIEWS

          H.R. 6306 Health Care Security Act of 2018 (Paulsen)

    H.R. 6306 (Paulsen, R-MN) increases health savings account 
(HSA) contribution limits to match the qualifying deductible 
and out-of-pocket maximum for a high-deductible health plan 
(HDHP) (for 2018, $6,650 for individuals and $13,500 for 
families) and allows individuals over 55 to make additional 
contributions (similar to catch-up provisions in other 
retirement savings accounts). The bill also would allow for 
HSA-eligible expenditures to be made in the 60 days prior to 
commencement of coverage under the HDHP. Individuals already 
struggling with medical bills do not have the disposable income 
to contribute to these tax shelters, and the increase in limits 
is a meaningless change that still leaves those who struggle to 
afford care without help.
    HSAs mostly benefit high-income taxpayers while doing 
little to help moderate-income families or the uninsured. 
Currently only five percent of HSA account holders contribute 
the annual maximum. This bill explicitly only helps the small 
proportion of high-income people who can best afford to save 
for health care expenses and are therefore the most likely to 
contribute to HSAs. Higher income filers are much more likely 
to establish HSAs than lower income filers-70 percent of HSA 
contributions come from households with incomes over $100,000, 
according to the Joint Commission on Taxation (JCT)--and they 
are also likelier to max out their contributions. Additionally, 
high-income individuals receive the biggest tax benefit for 
each dollar contributed to an HSA because the value of a tax 
deduction rises with an individual's tax bracket. More than 44 
percent of Americans cannot afford a $400 emergency visit. For 
these families, it is unlikely that they have excess income to 
devote to a tax-preferred account.
    Legislation busts the deficit to benefit the wealthy, 
again. Altogether, the 11 marked up in committee would add 
another $92 billion in unoffset tax cuts to the deficit. 
Republicans' attempts to expand HSAs (and encourage more 
enrollment in plans with high deductibles, covering very few 
up-front health costs) are a continuation of their platform of 
shifting families into health plans that provide fewer health 
benefits and higher out-of-pocket costs--while providing 
greater tax benefits for higher-income individuals and 
corporate special interests. According to 2014 Treasury data, 
only five percent of families with adjusted gross income of 
under $100,000 held money in an HSA, and those users' average 
account balances were $1,700.
    HDHPs and HSAs do not promote healthy behavior. It is 
widely acknowledged that HSAs and HDHPs lead consumers to delay 
care. They do not encourage individuals to make better health 
care decisions, as Republicans' ``skin in the game'' talking 
points assert. Decades of research shows that exposure to high 
out-of-pocket costs leads consumers to delay or forgo both 
necessary and unnecessary care. Delaying care and increasing 
costs run counter to Democratic policy goals of better 
coordinated, high-value affordable care for the American 
family.
    According to the American Hospital Association, ``Hospitals 
and health systems report that increased enrollment in HDHPs 
over the past several years has reduced access to care and 
subjected patients to costs they cannot afford. In addition, 
patients enrolled in HDHPs appear to delay care until they have 
reached their deductible or are in an emergency situation, 
which could lead to poorer health outcomes.''
    H.R. 6306 does not undo Republican sabotage, premium hikes, 
and benefit cuts they have caused over the past 18 months. This 
bill was one in a series of 11 bills this Committee marked up 
that Republicans claim will help lower health care costs for 
consumers. This legislation does not undo the disruption and 
sabotage the Republicans have continued to inflict on the 
American health care system. Instead of focusing on expansion 
of HSAs and HDHPs, Democrats encourage the Committee to 
redirect its attention to legislation that could actually 
ensure that uninsured, low-income, and vulnerable people have 
real access to care. For example H.R. 5155, sponsored by Reps. 
Pallone, Neal, and Scott would protect people with preexisting 
conditions, help lower premiums for Americans, and improve 
affordability of health coverage.
    JCT estimates the cost of this bill to be $15.3 billion 
over 10 years. With this bill Republicans are adding more tax 
cuts and increasing the deficit. Republicans are using the 
deficit, which they keep making larger with cuts for the 
wealthy, to justify the deep cuts they plan to make to Medicare 
and Medicaid. Republicans already are proposing to cut Medicare 
and Medicaid by nearly a trillion dollars to try to pay for the 
tax cuts they have already enacted. This bill will only 
increase Republicans' call for further cuts to these critical 
programs.
    Representative Doggett (D-TX) offered an amendment would 
require that a HDHP associated with an HSA covered under the 
underlying bill be offered by an issuer that does not 
discriminate or raise premiums on the basis of pre-existing 
conditions. This commonsense amendment was also defeated on 
party lines, 15-23.
    Representative Chu (D-CA) offered an amendment would allow 
individuals to use HSA funds to pay for health care expenses of 
minors separated from their parents by the Trump Administration 
without penalty. This compassionate amendment was also defeated 
on party lines, 16-22.
                                   Richard E. Neal,
                                           Ranking Member.

                                  [all]