[House Report 115-853]
[From the U.S. Government Publishing Office]


115th Congress }                                          { REPORT
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { 115-853

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

 THE ``RESPONSIBLE ADDITIONS AND INCREASES TO SUSTAIN EMPLOYEE HEALTH 
                         BENEFITS 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

                        [To accompany H.R. 6313]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6313) to amend the Internal Revenue Code of 1986 to 
provide that a plan shall not fail to be treated as a health 
flexible spending account merely because such arrangement's 
account balance (or any portion thereof) determined as of the 
end of any plan year may be carried forward to the succeeding 
plan year, report favorably thereon with an amendment and 
recommend that the bill as amended do pass.




115th Congress }                                          { REPORT
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { 115-853

======================================================================
 
RESPONSIBLE ADDITIONS AND INCREASES TO SUSTAIN EMPLOYEE HEALTH BENEFITS 
                              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. 6313]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6313) to amend the Internal Revenue Code of 1986 to 
allow the carryforward of health flexible spending arrangement 
account balances, 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............................................3
II. EXPLANATION OF THE BILL...........................................4
        A. Carryforward of Health Flexible Spending Arrangement 
            Account Balances.....................................     4
III.VOTES OF THE COMMITTEE............................................7

IV. BUDGET EFFECTS OF THE BILL........................................7
        A. Committee Estimate of Budgetary Effects...............     7
        B. Statement Regarding New Budget Authority and Tax 
            Expenditures Budget Authority........................    10
        C. Cost Estimate Prepared by the Congressional Budget 
            Office...............................................    10
 V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......10
        A. Committee Oversight Findings and Recommendations......    10
        B. Statement of General Performance Goals and Objectives.    10
        C. Information Relating to Unfunded Mandates.............    10
        D. Applicability of House Rule XXI 5(b)..................    11
        E. Tax Complexity Analysis...............................    11
        F. Congressional Earmarks, Limited Tax Benefits, and 
            Limited Tariff Benefits..............................    11
        G. Duplication of Federal Programs.......................    11
        H. Disclosure of Directed Rule Makings...................    11
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED............12
        B. Changes in Existing Law Proposed by the Bill, as 
            Reported.............................................    12

    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 ``Responsible Additions and Increases to 
Sustain Employee Health Benefits Act of 2018''.

SEC. 2. CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT ACCOUNT 
                    BALANCES.

  (a) In General.--Section 106 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new subsection:
  ``(h) Carryforward of Health Flexible Spending Arrangement Account 
Balances.--A plan shall not fail to be treated as a health flexible 
spending arrangement under this section or section 105 merely because 
such arrangement's account balance (or any portion thereof) determined 
as of the end of any plan year may be carried forward to the succeeding 
plan year.''.
  (b) Coordination With Limitation on Salary Reduction Contributions.--
          (1) In general.--Section 125(i) of such Code is amended by 
        redesignating paragraph (2) as paragraph (3) and by inserting 
        after paragraph (1) the following new paragraph:
          ``(2) Coordination with carryforward of account balances.--
        The dollar amount otherwise in effect under paragraph (1) for 
        any plan year shall be reduced by the excess (if any) of--
                  ``(A) the amount of any account balance which is 
                carried forward to such plan year from the preceding 
                plan year, over
                  ``(B) $500.''.
          (2) Conforming amendments.--Section 125(i) of such Code is 
        amended by striking ``taxable year'' each place it appears in 
        paragraphs (1) and (3) (as redesignated by paragraph (1) of 
        this subsection) and inserting ``plan year''.
  (c) Coordination With Cafeteria Plan Limitation on Deferred 
Compensation.--Section 125(d)(2) of such Code is amended by adding at 
the end the following new subparagraph:
                  ``(E) Exception for health flexible spending 
                arrangements.--Subparagraph (A) shall not apply to a 
                plan to the extent of amounts in a health flexible 
                spending arrangement which may be carried forward as 
                described in section 106(h).''.
  (d) Effective Date.--The amendment made by this section shall apply 
to plan years beginning after December 31, 2018.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill H.R. 6313, as reported by the Committee on Ways 
and Means, allows balances in Flexible Spending Arrangements 
(FSA) to be carried forward each year.

                 B. Background and Need for Legislation

    FSAs are employer-established accounts to reimburse 
employees for qualified medical expenses. They are usually 
funded through voluntary salary reduction agreements with the 
employer, but employers can also contribute. Contributions are 
not subject to payroll or federal income taxes. Contributions 
to FSAs are capped at $2,650 in 2018. FSAs are ``use-it-or-
lose-it'' arrangements, with the exception that employers may 
allow up to $500 to be carried over to the next year or allow a 
grace-period to use leftover funds during the first quarter of 
the next year.
    According to the Employee Benefits Survey conducted by the 
Department of Labor, 44 percent of all civilian workers had 
access to a health FSA offered under a cafeteria plan in 2017.
    The use-it-or-lose-it nature of FSAs can lead to 
unnecessary health care expenditures at the end of the year or 
underfunding of such accounts. If consumers are able to roll-
over their unused funds, they are more likely to become more 
economically efficient as this incentivizes consumers to only 
purchase what is needed. Additionally, the reduced spending of 
excess funds could have a positive effect on overall spending, 
including keeping premiums low through utilizing less services 
through the plan.

                         C. Legislative History


Background

    H.R. 6313 was introduced on July 6, 2018, and was referred 
to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 6313, the 
``Responsible Additions and Increases to Sustain Employee 
Health Benefits 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 Flexible Spending 
Accounts (FSAs) 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. Carryforward of Health Flexible Spending Arrangement Account 
                                Balances


                              PRESENT LAW

Exclusion from income for employer-provided health coverage

    Employees are not taxed on (i.e., may exclude from gross 
income) the value of employer-provided health coverage under an 
accident or health plan.\1\ In addition, any reimbursements 
under an employer-provided accident or health plan for medical 
care expenses for employees, their spouses, their dependents, 
and adult children under age 27 generally are excluded from 
gross income.\2\ The exclusion applies both to health coverage 
in the case in which an employer directly pays the cost of 
employees' medical expenses not covered by insurance (i.e., a 
self-insured plan) and an employer purchased health insurance 
coverage for its employees. There generally is no limit on the 
amount of employer-provided health coverage that is excludable. 
A similar rule excludes employer-provided health insurance 
coverage from the employees' wages for employment tax 
purposes.\3\
---------------------------------------------------------------------------
    \1\Sec. 106.
    \2\Sec. 105(b).
    \3\Secs. 3121(a)(2), 3231(e)(1), and 3306(a)(2).
---------------------------------------------------------------------------
    Employers may also provide health coverage in the form of 
an agreement to reimburse medical expenses of their employees, 
their spouses, their dependents, and adult children under age 
27, not reimbursed by a health insurance plan, through 
arrangements which allow reimbursement for medical care not in 
excess of a specified dollar amount (either elected by an 
employee under a cafeteria plan or otherwise specified by the 
employer). An employer may agree to reimburse expenses for 
medical care of its employees (and their spouses and 
dependents), not covered by a health insurance plan, through a 
flexible spending arrangement (``FSA'') which allows 
reimbursement for medical expenses not in excess of a specified 
dollar amount. The amounts available for reimbursement must be 
exclusively for reimbursement for medical care.\4\
---------------------------------------------------------------------------
    \4\Treas. Reg. sec. 1.105-2.
---------------------------------------------------------------------------
    Reimbursements may be either elected by an employee under a 
cafeteria plan or otherwise specified by the employer under a 
health reimbursement arrangement (``HRA''). Reimbursements 
under these arrangements are excludable from gross income as 
reimbursements for medical care under employer-provided health 
coverage.\5\
---------------------------------------------------------------------------
    \5\Sec. 106.
---------------------------------------------------------------------------

Cafeteria plan

            General rules
    A cafeteria plan is a separate written plan of an employer 
under which all participants are employees, and participants 
are permitted to choose among at least one permitted taxable 
benefit (e.g., current cash compensation) and at least one 
qualified benefit (generally an employer-provided benefit 
excludable from gross income, such as employer-provided health 
coverage). If an employee receives a qualified benefit based on 
his or her election between the qualified benefit and a taxable 
benefit under a cafeteria plan, the qualified benefit generally 
is not includible in gross income.\6\ The amount of the cash 
compensation forgone pursuant to an election under a cafeteria 
plan is generally referred to as a salary reduction 
contribution. However, if a plan offering an employee an 
election between taxable benefits (including cash) and 
nontaxable qualified benefits does not meet the requirements 
for being a cafeteria plan, the election between taxable and 
nontaxable benefits generally results in gross income to the 
employee, regardless of what benefit is elected and when the 
election is made.\7\ A cafeteria plan generally may not provide 
for deferral of compensation.
---------------------------------------------------------------------------
    \6\Sec. 125(a). To be excludable, however, any qualified benefit 
elected under a cafeteria plan must independently satisfy any 
requirements under the Code section that provides the exclusion, such 
as section 105(b) or 106.
    \7\Prop. Treas. Reg. sec. 1.125-1(b).
---------------------------------------------------------------------------
            Health flexible spending arrangement under a cafeteria plan
    A flexible spending arrangement for medical expenses under 
a cafeteria plan (commonly called a ``health FSA'') is health 
coverage in the form of an arrangement under which employees 
are given the option to reduce their current cash compensation 
and instead have the amount of the salary reduction 
contributions made available for use in reimbursing the 
employee for his or her medical expenses.\8\ For 2018, the 
maximum amount of salary reduction contributions for a year is 
limited to $2,650.\9\
---------------------------------------------------------------------------
    \8\Sec. 125 and Prop. Treas. Reg. sec. 1.125-5.
    \9\Rev. Proc. 2017-58, 2017-45 I.R.B. 489 (Nov. 6, 2017).
---------------------------------------------------------------------------
    Health FSAs are subject to the general requirements for 
cafeteria plans, including a requirement that such plans may 
not be plans of deferred compensation. This generally means 
that amounts remaining under a health FSA at the end of a plan 
year must be forfeited by the employee (referred to as the 
``use-it-or-lose-it'' rule).\10\ However, guidance provides a 
grace period of two and one-half months after the end of the 
plan year for the carryover of excess benefits or contributions 
in a health FSA.\11\ As an alternative to a grace period, an 
employer may amend the cafeteria plan document to provide for 
$500 of any unused amounts in a health FSA to be continuously 
rolled over.\12\ If an employee leaves employment during a year 
and has a balance in a health FSA (but no eligible unreimbursed 
medical expenses), that amount will be forfeited.
---------------------------------------------------------------------------
    \10\See sec. 125(d)(2).
    \11\See, e.g., Notice 2005-42, 2005-23 I.R.B. 1204 (June 6, 2005).
    \12\See Notice 2013-71, 2013-47, I.R.B. 532 (November 18, 2013).
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that health FSAs are an important 
tool in managing health care costs because amounts contributed 
to a health FSA are available in their entirety on the first 
day of the plan year, rather than needing to be accumulated in 
a fund before becoming available to pay for medical care costs. 
However, health FSAs are constrained by the use-it-or-lose-it 
rule because, at the end of a year, if an individual has a 
balance in his or her health FSA that he or she believes may be 
lost, the individual is more likely to spend those amounts on 
medical care that they might not otherwise have chosen to do 
(or need to do) leading to inefficient consumer health 
spending.
    The Committee believes that if an individual is permitted 
to carry forward those amounts to future years, they will more 
likely purchase medical care only when there is a need for such 
care, leading to better containment of health costs.

                        EXPLANATION OF PROVISION

    Under the provision, a plan shall not fail to be treated as 
a health flexible spending arrangement merely because such 
arrangement's account balance (or any portion thereof) 
determined as of the end of any plan year may be carried 
forward to the succeeding plan year. The dollar amount that may 
be contributed to an FSA in any plan year in which the amount 
of any balance (or any portion of the balance) from the 
preceding plan year is carried forward to such plan year will 
be reduced by the excess, if any, of the amount of the account 
balance that is carried forward to such plan year from the 
preceding plan year over $500. To the extent that amounts in a 
health flexible spending arrangement may be carried forward as 
of the end of any plan year to the succeeding plan year, the 
carryover of such amounts will not cause the cafeteria plan to 
be treated as a plan which provides deferred compensation.

                             EFFECTIVE DATE

    The provision is effective for plan years 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. 6313, the ``Responsible Additions and 
Increases to Sustain Employee Health Benefits Act of 2018,'' on 
July 12, 2018.
    H.R. 6313 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 14 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.....  ........  ........  .........
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....................  ........  ........  .........  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. 6313, 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
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Permit Rollovers of Health Flexible Spending Arrangement            -33        -51        -60        -64        -66        -67        -68        -74        -75        -75       -274       -634
 Account Balances \1\.......................................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details do not add to totals due to rounding.


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Estimate includes the following off-budget effects......        -11        -17        -20        -21        -22        -22        -22        -23        -23        -23        -91       -204
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    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 III--ITEMS SPECIFICALLY EXCLUDED FROM GROSS INCOME

           *       *       *       *       *       *       *



SEC. 106. CONTRIBUTIONS BY EMPLOYER TO ACCIDENT AND HEALTH PLANS.

  (a) General rule.--Except as otherwise provided in this 
section, gross income of an employee does not include employer-
provided coverage under an accident or health plan.
  (b) Contributions to Archer MSAs.--
          (1) In general.--In the case of an employee who is an 
        eligible individual, amounts contributed by such 
        employee's employer to any Archer MSA of such employee 
        shall be treated as employer-provided coverage for 
        medical expenses under an accident or health plan to 
        the extent such amounts do not exceed the limitation 
        under section 220(b)(1) (determined without regard to 
        this subsection) which is applicable to such employee 
        for such taxable year.
          (2) No constructive receipt.--No amount shall be 
        included in the gross income of any employee solely 
        because the employee may choose between the 
        contributions referred to in paragraph (1) and employer 
        contributions to another health plan of the employer.
          (3) Special rule for deduction of employer 
        contributions.--Any employer contribution to an Archer 
        MSA, if otherwise allowable as a deduction under this 
        chapter, shall be allowed only for the taxable year in 
        which paid.
          (4) Employer MSA contributions required to be shown 
        on return.--Every individual required to file a return 
        under section 6012 for the taxable year shall include 
        on such return the aggregate amount contributed by 
        employers to the Archer MSAs of such individual or such 
        individual's spouse for such taxable year.
          (5) MSA contributions not part of COBRA coverage.--
        Paragraph (1) shall not apply for purposes of section 
        4980B.
          (6) Definitions.--For purposes of this subsection, 
        the terms ``eligible individual'' and ``Archer MSA'' 
        have the respective meanings given to such terms by 
        section 220.
          (7) Cross reference.--For penalty on failure by 
        employer to make comparable contributions to the Archer 
        MSAs of comparable employees, see section 4980E.
  (c) Inclusion of long-term care benefits provided through 
flexible spending arrangements.--
          (1) In general.--Gross income of an employee shall 
        include employer-provided coverage for qualified long-
        term care services (as defined in section 7702B(c)) to 
        the extent that such coverage is provided through a 
        flexible spending or similar arrangement.
          (2) Flexible spending arrangement.--For purposes of 
        this subsection, a flexible spending arrangement is a 
        benefit program which provides employees with coverage 
        under which--
                  (A) specified incurred expenses may be 
                reimbursed (subject to reimbursement maximums 
                and other reasonable conditions), and
                  (B) the maximum amount of reimbursement which 
                is reasonably available to a participant for 
                such coverage is less than 500 percent of the 
                value of such coverage.
        In the case of an insured plan, the maximum amount 
        reasonably available shall be determined on the basis 
        of the underlying coverage.
  (d) Contributions to health savings accounts.--
          (1) In general.--In the case of an employee who is an 
        eligible individual (as defined in section 223(c)(1)), 
        amounts contributed by such employee's employer to any 
        health savings account (as defined in section 223(d)) 
        of such employee shall be treated as employer-provided 
        coverage for medical expenses under an accident or 
        health plan to the extent such amounts do not exceed 
        the limitation under section 223(b) (determined without 
        regard to this subsection) which is applicable to such 
        employee for such taxable year.
          (2) Special rules.--Rules similar to the rules of 
        paragraphs (2), (3), (4), and (5) of subsection (b) 
        shall apply for purposes of this subsection.
          (3) Cross reference.--For penalty on failure by 
        employer to make comparable contributions to the health 
        savings accounts of comparable employees, see section 
        4980G.
  (e) FSA and HRA Terminations to Fund HSAs.--
          (1) In general.--A plan shall not fail to be treated 
        as a health flexible spending arrangement or health 
        reimbursement arrangement under this section or section 
        105 merely because such plan provides for a qualified 
        HSA distribution.
          (2) Qualified HSA distribution.--The term ``qualified 
        HSA distribution'' means a distribution from a health 
        flexible spending arrangement or health reimbursement 
        arrangement to the extent that such distribution--
                  (A) does not exceed the lesser of the balance 
                in such arrangement on September 21, 2006, or 
                as of the date of such distribution, and
                  (B) is contributed by the employer directly 
                to the health savings account of the employee 
                before January 1, 2012.
        Such term shall not include more than 1 distribution 
        with respect to any arrangement.
          (3) Additional tax for failure to maintain high 
        deductible health plan coverage.--
                  (A) In general.--If, at any time during the 
                testing period, the employee is not an eligible 
                individual, then the amount of the qualified 
                HSA distribution--
                          (i) shall be includible in the gross 
                        income of the employee for the taxable 
                        year in which occurs the first month in 
                        the testing period for which such 
                        employee is not an eligible individual, 
                        and
                          (ii) the tax imposed by this chapter 
                        for such taxable year on the employee 
                        shall be increased by 10 percent of the 
                        amount which is so includible.
                  (B) Exception for disability or death.--
                Clauses (i) and (ii) of subparagraph (A) shall 
                not apply if the employee ceases to be an 
                eligible individual by reason of the death of 
                the employee or the employee becoming disabled 
                (within the meaning of section 72(m)(7)).
          (4) Definitions and special rules.--For purposes of 
        this subsection--
                  (A) Testing period.--The term ``testing 
                period'' means the period beginning with the 
                month in which the qualified HSA distribution 
                is contributed to the health savings account 
                and ending on the last day of the 12th month 
                following such month.
                  (B) Eligible individual.--The term ``eligible 
                individual'' has the meaning given such term by 
                section 223(c)(1).
                  (C) Treatment as rollover contribution.--A 
                qualified HSA distribution shall be treated as 
                a rollover contribution described in section 
                223(f)(5).
          (5) Tax treatment relating to distributions.--For 
        purposes of this title--
                  (A) In general.--A qualified HSA distribution 
                shall be treated as a payment described in 
                subsection (d).
                  (B) Comparability excise tax.--
                          (i) In general.--Except as provided 
                        in clause (ii), section 4980G shall not 
                        apply to qualified HSA distributions.
                          (ii) Failure to offer to all 
                        employees.--In the case of a qualified 
                        HSA distribution to any employee, the 
                        failure to offer such distribution to 
                        any eligible individual covered under a 
                        high deductible health plan of the 
                        employer shall (notwithstanding section 
                        4980G(d)) be treated for purposes of 
                        section 4980G as a failure to meet the 
                        requirements of section 4980G(b).
  (f) Reimbursements for medicine restricted to prescribed 
drugs and insulin.--For purposes of this section and section 
105, reimbursement for expenses incurred for a medicine or a 
drug shall be treated as a reimbursement for medical expenses 
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.
  (g) Qualified small employer health reimbursement 
arrangement.--For purposes of this section and section 105, 
payments or reimbursements from a qualified small employer 
health reimbursement arrangement (as defined in section 
9831(d)) of an individual for medical care (as defined in 
section 213(d)) shall not be treated as paid or reimbursed 
under employer-provided coverage for medical expenses under an 
accident or health plan if for the month in which such medical 
care is provided the individual does not have minimum essential 
coverage (within the meaning of section 5000A(f)).
  (h) Carryforward of Health Flexible Spending Arrangement 
Account Balances.--A plan shall not fail to be treated as a 
health flexible spending arrangement under this section or 
section 105 merely because such arrangement's account balance 
(or any portion thereof) determined as of the end of any plan 
year may be carried forward to the succeeding plan year.

           *       *       *       *       *       *       *


SEC. 125. CAFETERIA PLANS.

  (a) General rule.--Except as provided in subsection (b), no 
amount shall be included in the gross income of a participant 
in a cafeteria plan solely because, under the plan, the 
participant may choose among the benefits of the plan.
  (b) Exception for highly compensated participants and key 
employees.--
          (1) Highly compensated participants.--In the case of 
        a highly compensated participant, subsection (a) shall 
        not apply to any benefit attributable to a plan year 
        for which the plan discriminates in favor of--
                  (A) highly compensated individuals as to 
                eligibility to participate, or
                  (B) highly compensated participants as to 
                contributions and benefits.
          (2) Key employees.--In the case of a key employee 
        (within the meaning of section 416(i)(1)), subsection 
        (a) shall not apply to any benefit attributable to a 
        plan for which the qualified benefits provided to key 
        employees exceed 25 percent of the aggregate of such 
        benefits provided for all employees under the plan. For 
        purposes of the preceding sentence, qualified benefits 
        shall be determined without regard to the second 
        sentence of subsection (f).
          (3) Year of inclusion.--For purposes of determining 
        the taxable year of inclusion, any benefit described in 
        paragraph (1) or (2) shall be treated as received or 
        accrued in the taxable year of the participant or key 
        employee in which the plan year ends.
  (c) Discrimination as to benefits or contributions.--For 
purposes of subparagraph (B) of subsection (b)(1), a cafeteria 
plan does not discriminate where qualified benefits and total 
benefits (or employer contributions allocable to qualified 
benefits and employer contributions for total benefits) do not 
discriminate in favor of highly compensated participants.
  (d) Cafeteria plan defined.--For purposes of this section--
          (1) In general.--The term ``cafeteria plan'' means a 
        written plan under which--
                  (A) all participants are employees, and
                  (B) the participants may choose among 2 or 
                more benefits consisting of cash and qualified 
                benefits.
          (2) Deferred compensation plans excluded.--
                  (A) In general.--The term ``cafeteria plan'' 
                does not include any plan which provides for 
                deferred compensation.
                  (B) Exception for cash and deferred 
                arrangements.--Subparagraph (A) shall not apply 
                to a profit-sharing or stock bonus plan or 
                rural cooperative plan (within the meaning of 
                section 401(k)(7)) which includes a qualified 
                cash or deferred arrangement (as defined in 
                section 401(k)(2)) to the extent of amounts 
                which a covered employee may elect to have the 
                employer pay as contributions to a trust under 
                such plan on behalf of the employee.
                  (C) Exception for certain plans maintained by 
                educational institutions.--Subparagraph (A) 
                shall not apply to a plan maintained by an 
                educational organization described in section 
                170(b)(1)(A)(ii) to the extent of amounts which 
                a covered employee may elect to have the 
                employer pay as contributions for post-
                retirement group life insurance if--
                          (i) all contributions for such 
                        insurance must be made before 
                        retirement, and
                          (ii) such life insurance does not 
                        have a cash surrender value at any 
                        time.
                For purposes of section 79, any life insurance 
                described in the preceding sentence shall be 
                treated as group-term life insurance.
                  (D) Exception for health savings accounts.--
                Subparagraph (A) shall not apply to a plan to 
                the extent of amounts which a covered employee 
                may elect to have the employer pay as 
                contributions to a health savings account 
                established on behalf of the employee.
                  (E) Exception for health flexible spending 
                arrangements.--Subparagraph (A) shall not apply 
                to a plan to the extent of amounts in a health 
                flexible spending arrangement which may be 
                carried forward as described in section 106(h).
  (e) Highly compensated participant and individual defined.--
For purposes of this section--
          (1) Highly compensated participant.--The term 
        ``highly compensated participant'' means a participant 
        who is--
                  (A) an officer,
                  (B) a shareholder owning more than 5 percent 
                of the voting power or value of all classes of 
                stock of the employer,
                  (C) highly compensated, or
                  (D) a spouse or dependent (within the meaning 
                of section 152, determined without regard to 
                subsections (b)(1), (b)(2), and (d)(1)(B) 
                thereof) of an individual described in 
                subparagraph (A), (B), or (C).
          (2) Highly compensated individual.--The term ``highly 
        compensated individual'' means an individual who is 
        described in subparagraph (A), (B), (C), or (D) of 
        paragraph (1).
  (f) Qualified benefits defined.--For purposes of this 
section--
          (1) In general.--The term ``qualified benefit'' means 
        any benefit which, with the application of subsection 
        (a), is not includible in the gross income of the 
        employee by reason of an express provision of this 
        chapter (other than section 106(b), 117, 127, or 132). 
        Such term includes any group term life insurance which 
        is includible in gross income only because it exceeds 
        the dollar limitation of section 79 and such term 
        includes any other benefit permitted under regulations.
          (2) Long-term care insurance not qualified.--The term 
        ``qualified benefit'' shall not include any product 
        which is advertised, marketed, or offered as long-term 
        care insurance.
          (3) Certain exchange-participating qualified health 
        plans not qualified.--
                  (A) In general.--The term ``qualified 
                benefit'' shall not include any qualified 
                health plan (as defined in section 1301(a) of 
                the Patient Protection and Affordable Care Act) 
                offered through an Exchange established under 
                section 1311 of such Act.
                  (B) Exception for exchange-eligible 
                employers.--Subparagraph (A) shall not apply 
                with respect to any employee if such employee's 
                employer is a qualified employer (as defined in 
                section 1312(f)(2) of the Patient Protection 
                and Affordable Care Act) offering the employee 
                the opportunity to enroll through such an 
                Exchange in a qualified health plan in a group 
                market.
  (g) Special rules.--
          (1) Collectively bargained plan not considered 
        discriminatory.--For purposes of this section, a plan 
        shall not be treated as discriminatory if the plan is 
        maintained under an agreement which the Secretary finds 
        to be a collective bargaining agreement between 
        employee representatives and one or more employers.
          (2) Health benefits.--For purposes of subparagraph 
        (B) of subsection (b)(1), a cafeteria plan which 
        provides health benefits shall not be treated as 
        discriminatory if--
                  (A) contributions under the plan on behalf of 
                each participant include an amount which--
                          (i) equals 100 percent of the cost of 
                        the health benefit coverage under the 
                        plan of the majority of the highly 
                        compensated participants similarly 
                        situated, or
                          (ii) equals or exceeds 75 percent of 
                        the cost of the health benefit coverage 
                        of the participant (similarly situated) 
                        having the highest cost health benefit 
                        coverage under the plan, and
                  (B) contributions or benefits under the plan 
                in excess of those described in subparagraph 
                (A) bear a uniform relationship to 
                compensation.
          (3) Certain participation eligibility rules not 
        treated as discriminatory.--For purposes of 
        subparagraph (A) of subsection (b)(1), a classification 
        shall not be treated as discriminatory if the plan--
                  (A) benefits a group of employees described 
                in section 410(b)(2)(A)(i), and
                  (B) meets the requirements of clauses (i) and 
                (ii):
                          (i) No employee is required to 
                        complete more than 3 years of 
                        employment with the employer or 
                        employers maintaining the plan as a 
                        condition of participation in the plan, 
                        and the employment requirement for each 
                        employee is the same.
                          (ii) Any employee who has satisfied 
                        the employment requirement of clause 
                        (i) and who is otherwise entitled to 
                        participate in the plan commences 
                        participation no later than the first 
                        day of the first plan year beginning 
                        after the date the employment 
                        requirement was satisfied unless the 
                        employee was separated from service 
                        before the first day of that plan year.
          (4) Certain controlled groups, etc..--All employees 
        who are treated as employed by a single employer under 
        subsection (b), (c), or (m) of section 414 shall be 
        treated as employed by a single employer for purposes 
        of this section.
  (h) Special rule for unused benefits in health flexible 
spending arrangements of individuals called to active duty.--
          (1) In general.--For purposes of this title, a plan 
        or other arrangement shall not fail to be treated as a 
        cafeteria plan or health flexible spending arrangement 
        (and shall not fail to be treated as an accident or 
        health plan) merely because such arrangement provides 
        for qualified reservist distributions.
          (2) Qualified reservist distribution.--For purposes 
        of this subsection, the term ``qualified reservist 
        distribution'' means any distribution to an individual 
        of all or a portion of the balance in the employee's 
        account under such arrangement if--
                  (A) such individual was (by reason of being a 
                member of a reserve component (as defined in 
                section 101 of title 37, United States Code)) 
                ordered or called to active duty for a period 
                in excess of 179 days or for an indefinite 
                period, and
                  (B) such distribution is made during the 
                period beginning on the date of such order or 
                call and ending on the last date that 
                reimbursements could otherwise be made under 
                such arrangement for the plan year which 
                includes the date of such order or call.
  (i) Limitation on health flexible spending arrangements.--
          (1) In general.--For purposes of this section, if a 
        benefit is provided under a cafeteria plan through 
        employer contributions to a health flexible spending 
        arrangement, such benefit shall not be treated as a 
        qualified benefit unless the cafeteria plan provides 
        that an employee may not elect for any [taxable year] 
        plan year to have salary reduction contributions in 
        excess of $2,500 made to such arrangement.
          (2) Coordination with carryforward of account 
        balances.--The dollar amount otherwise in effect under 
        paragraph (1) for any plan year shall be reduced by the 
        excess (if any) of--
                  (A) the amount of any account balance which 
                is carried forward to such plan year from the 
                preceding plan year, over
                  (B) $500.
          [(2)] (3) Adjustment for inflation.--In the case of 
        any [taxable year] plan year beginning after December 
        31, 2013, the dollar amount in paragraph (1) shall be 
        increased by an amount equal to--
                  (A) such amount, multiplied by
                  (B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in 
                which such [taxable year] plan year begins by 
                substituting ``calendar year 2012'' for 
                ``calendar year 2016'' in subparagraph (A)(ii) 
                thereof.
        If any increase determined under this paragraph is not 
        a multiple of $50, such increase shall be rounded to 
        the next lowest multiple of $50.
  (j) Simple cafeteria plans for small businesses.--
          (1) In general.--An eligible employer maintaining a 
        simple cafeteria plan with respect to which the 
        requirements of this subsection are met for any year 
        shall be treated as meeting any applicable 
        nondiscrimination requirement during such year.
          (2) Simple cafeteria plan.--For purposes of this 
        subsection, the term ``simple cafeteria plan'' means a 
        cafeteria plan--
                  (A) which is established and maintained by an 
                eligible employer, and
                  (B) with respect to which the contribution 
                requirements of paragraph (3), and the 
                eligibility and participation requirements of 
                paragraph (4), are met.
          (3) Contribution requirements.--
                  (A) In general.--The requirements of this 
                paragraph are met if, under the plan the 
                employer is required, without regard to whether 
                a qualified employee makes any salary reduction 
                contribution, to make a contribution to provide 
                qualified benefits under the plan on behalf of 
                each qualified employee in an amount equal to--
                          (i) a uniform percentage (not less 
                        than 2 percent) of the employee's 
                        compensation for the plan year, or
                          (ii) an amount which is not less than 
                        the lesser of--
                                  (I) 6 percent of the 
                                employee's compensation for the 
                                plan year, or
                                  (II) twice the amount of the 
                                salary reduction contributions 
                                of each qualified employee.
                  (B) Matching contributions on behalf of 
                highly compensated and key employees.--The 
                requirements of subparagraph (A)(ii) shall not 
                be treated as met if, under the plan, the rate 
                of contributions with respect to any salary 
                reduction contribution of a highly compensated 
                or key employee at any rate of contribution is 
                greater than that with respect to an employee 
                who is not a highly compensated or key 
                employee.
                  (C) Additional contributions.--Subject to 
                subparagraph (B), nothing in this paragraph 
                shall be treated as prohibiting an employer 
                from making contributions to provide qualified 
                benefits under the plan in addition to 
                contributions required under subparagraph (A).
                  (D) Definitions.--For purposes of this 
                paragraph--
                          (i) Salary reduction contribution.--
                        The term ``salary reduction 
                        contribution'' means, with respect to a 
                        cafeteria plan, any amount which is 
                        contributed to the plan at the election 
                        of the employee and which is not 
                        includible in gross income by reason of 
                        this section.
                          (ii) Qualified employee.--The term 
                        ``qualified employee'' means, with 
                        respect to a cafeteria plan, any 
                        employee who is not a highly 
                        compensated or key employee and who is 
                        eligible to participate in the plan.
                          (iii) Highly compensated employee.--
                        The term ``highly compensated 
                        employee'' has the meaning given such 
                        term by section 414(q).
                          (iv) Key employee.--The term ``key 
                        employee'' has the meaning given such 
                        term by section 416(i).
          (4) Minimum eligibility and participation 
        requirements.--
                  (A) In general.--The requirements of this 
                paragraph shall be treated as met with respect 
                to any year if, under the plan--
                          (i) all employees who had at least 
                        1,000 hours of service for the 
                        preceding plan year are eligible to 
                        participate, and
                          (ii) each employee eligible to 
                        participate in the plan may, subject to 
                        terms and conditions applicable to all 
                        participants, elect any benefit 
                        available under the plan.
                  (B) Certain employees may be excluded.--For 
                purposes of subparagraph (A)(i), an employer 
                may elect to exclude under the plan employees--
                          (i) who have not attained the age of 
                        21 before the close of a plan year,
                          (ii) who have less than 1 year of 
                        service with the employer as of any day 
                        during the plan year,
                          (iii) who are covered under an 
                        agreement which the Secretary of Labor 
                        finds to be a collective bargaining 
                        agreement if there is evidence that the 
                        benefits covered under the cafeteria 
                        plan were the subject of good faith 
                        bargaining between employee 
                        representatives and the employer, or
                          (iv) who are described in section 
                        410(b)(3)(C) (relating to nonresident 
                        aliens working outside the United 
                        States).
                A plan may provide a shorter period of service 
                or younger age for purposes of clause (i) or 
                (ii).
          (5) Eligible employer.--For purposes of this 
        subsection--
                  (A) In general.--The term ``eligible 
                employer'' means, with respect to any year, any 
                employer if such employer employed an average 
                of 100 or fewer employees on business days 
                during either of the 2 preceding years. For 
                purposes of this subparagraph, a year may only 
                be taken into account if the employer was in 
                existence throughout the year.
                  (B) Employers not in existence during 
                preceding year.--If an employer was not in 
                existence throughout the preceding year, the 
                determination under subparagraph (A) shall be 
                based on the average number of employees that 
                it is reasonably expected such employer will 
                employ on business days in the current year.
                  (C) Growing employers retain treatment as 
                small employer.--
                          (i) In general.--If--
                                  (I) an employer was an 
                                eligible employer for any year 
                                (a ``qualified year''), and
                                  (II) such employer 
                                establishes a simple cafeteria 
                                plan for its employees for such 
                                year,
                        then, notwithstanding the fact the 
                        employer fails to meet the requirements 
                        of subparagraph (A) for any subsequent 
                        year, such employer shall be treated as 
                        an eligible employer for such 
                        subsequent year with respect to 
                        employees (whether or not employees 
                        during a qualified year) of any trade 
                        or business which was covered by the 
                        plan during any qualified year.
                          (ii) Exception.--This subparagraph 
                        shall cease to apply if the employer 
                        employs an average of 200 or more 
                        employees on business days during any 
                        year preceding any such subsequent 
                        year.
                  (D) Special rules.--
                          (i) Predecessors.--Any reference in 
                        this paragraph to an employer shall 
                        include a reference to any predecessor 
                        of such employer.
                          (ii) Aggregation rules.--All persons 
                        treated as a single employer under 
                        subsection (a) or (b) of section 52, or 
                        subsection (n) or (o) of section 414, 
                        shall be treated as one person.
          (6) Applicable nondiscrimination requirement.--For 
        purposes of this subsection, the term ``applicable 
        nondiscrimination requirement'' means any requirement 
        under subsection (b) of this section, section 79(d), 
        section 105(h), or paragraph (2), (3), (4), or (8) of 
        section 129(d).
          (7) Compensation.--The term ``compensation'' has the 
        meaning given such term by section 414(s).
  (k) Cross reference.--For reporting and recordkeeping 
requirements, see section 6039D.
  (l) Regulations.--The Secretary shall prescribe such 
regulations as may be necessary to carry out the provisions of 
this section.

           *       *       *       *       *       *       *


                            DISSENTING VIEWS

   H.R. 6313 Responsible Additions and Increases to Sustain Employee 
                      Health Benefits Act of 2018

    H.R. 6313 (Stivers, R-OH) allows individuals to rollover 
Flexible Spending Account (FSA) contributions.
    H.R. 6313 does not undo sabotage, premium hikes, and 
benefit cuts Republicans have caused over the past 18 months. 
This bill was one in a series of 11 bills the 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 tax-preferred accounts, 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 pre-existing 
conditions, help lower premiums for Americans, and improve 
affordability of health coverage.
    The Joint Committee on Taxation (JCT) estimates the cost of 
this bill to be $634 million over 10 years. Altogether the 11 
bills the Committee marked up would add another $92 billion in 
unoffset tax cuts to the deficit. With these bills, 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.

                                   Richard E. Neal,
                                           Ranking Member

                                  [all]