Members of the U.S. House are rushing to update the federal law that governs preventive benefits coverage for people with health savings accounts.
House leaders have put a bipartisan HSA preventive benefits bill, the Chronic Disease Flexible Coverage Act bill, on a list of items that could come to the House floor this week “under suspension of the rules.”
The House uses the suspension process to handle popular bills that are expected to pass without much opposition.
The bill heading toward the floor would make the current Internal Revenue Services rules for preventive care coverage in HSA-compatible health plans more permanent, by making the rules federal law.
The backdrop: HSAs give people the ability to contribute income to a health account without paying federal income taxes either on the contributions or distributions used to pay for services and items that qualify for special tax treatment.
Federal law requires people who use HSAs to combine them with “high-deductible health plan,” or HDHP, coverage.
One reason is to reduce the impact of HSA tax breaks on federal tax revenue.
Another reason is to encourage HSA users to shop for health care based on price as well as quality and convenience.
For 2025, HSA-compatible HDHP coverage must have a deductible of at least $1,650 for self-only coverage or $3,300 for family coverage.
The Affordable Care Act of 2010 requires HDHP issuers to cover basic preventive services, such as checkups and vaccinations, without imposing deductibles, co-payments or coinsurance amounts on the insureds, even before the insureds have met their deductibles.
In 2019, the IRS issued a notice, or semiformal batch of “guidance,” that expanded the list of preventive care products and services that an HDHP can cover without imposing deductibles or other cost-sharing requirements on the patients. The notice included items that can keep people who already have chronic health conditions from suffering from deadly, expensive complications, such as heart attacks.
The list of items includes statins and cholesterol tests for people with heart disease; beta blockers for people with congestive heart failure or coronary artery disease; and insulin, blood sugar testing devices and blood sugar tests for people with diabetes.
Since then, the IRS has continued to use informal guidance to let HDHP issuers treat some items used by people who already have chronic conditions as preventive care items.
The Chronic Disease Flexible Coverage Act bill: The new HSA benefits bill would create a law endorsing the idea of HDHP issuers treating the chronic care items and services in the 2019 IRS notice as preventive care items.
The bill would not change the current rules, but it could make health insurers, administrators of self-funded employer health plans and others more confident that the current HDHP preventive care coverage rules will stay in place.
Rep. Vern Buchanan, R-Fla., the chairman of the House Ways and Means health subcommittee, introduced the bill together with Rep. Jimmy Panetta, D-Calif.
A similar bill was introduced in the previous Congress, which ended Jan. 2. The House passed that bill by a voice vote in September, but it ended up dying in committee in the U.S. Senate, which then was under the control of the Democrats.
Now that both the House and Senate are both under the control of the Republicans, the odds of the bill becoming law may be higher.