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HSA bills further split Ways and Means

Sep 28, 2023

Ways and Means Chair Jason Smith speaking today at a House Oversight Committee hearing. Photo: Drew Angerer/Getty Images

The House Ways and Means Committee marked up two health savings account bills Thursday afternoon, reviving another long-held GOP health policy in a new legislative package.

Why it matters: Advancing the legislation marks another slow drip in GOP efforts to expand HSAs and access to direct primary care — two of their primary health care goals in the aftermath of the failed 2017 repeal-replace effort.

  • The committee was still in the process of marking up the bills and hadn't voted yet when we sent this story.

Details: The two bills would expand the use of HSAs, with one being bipartisan and the other solely GOP-led.

  • The bipartisan measure was led by Reps. Earl Blumenauer and Lloyd Smucker. It would allow HSAs to be used to pay for the monthly subscription of direct primary care services, and allow those who get care from an on-site employee clinic to use HSAs.
  • The other bill, led by Rep. Beth Van Duyne, would significantly expand who could contribute to HSAs.
  • It would alter the tax code to allow contributions from Medicare Part A beneficiaries who now can't contribute to HSAs once they enroll, as well as veterans without disabilities, Indian Health Service beneficiaries and those with ACA plans in the Bronze or Catastrophic categories.

Of note: The Committee for a Responsible Federal Budget estimated that the two HSA bills would increase the deficit by $71 billion through FY2033, with $12 billion of revenue losses in that year alone.

  • The legislation had no payfors included.

The intrigue: Though Democrats Blumenauer and Brad Schneider are cosponsoring one of the bills, several Democrat-aligned groups came out against both pieces of legislation before the markup.

  • Both the Center on Budget and Policy Priorities and Protect Our Care put out statements saying the measures would increase tax breaks, benefit the wealthy and exacerbate health disparities.
  • Blumenauer told Axios on Wednesday that he expected his bill to be bipartisan, saying "several [Democrats] had supported it before."
  • Similar versions of the direct primary care bill have previously been reported favorably out of the committee with bipartisan support.
  • But several Democrats during the hearing said that although they supported the direct primary care provision, they opposed the rest of the package.
  • And Ranking Member Richard Neal wasn't on board.
  • "Expanding HSAs won't expand access to health coverage or bring down health care costs for the vast majority of Americans.... The bill is full of recycled ideas that didn't become law the last time they were brought up. And certainly won't become law now," Neal said.

Flashback: The Ways and Means committee has split along partisan lines on other health care legislation, most notably over the transparency package that passed out of the committee in July.

  • Ways and Means Democrats objected to the lack of private equity reporting requirements, even though Energy and Commerce Democrats supported the package.
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