H.R.1157 - Affordable Care and Comprehensive Economic Support through Savings Act; ACCESS Act (119th Congress)
Summary
H.R.1157, the ACCESS Act, proposes to amend the Internal Revenue Code and the Patient Protection and Affordable Care Act (ACA) to allow individuals enrolled in health insurance exchanges to elect to receive contributions to a health savings account (HSA) in lieu of reduced cost-sharing. This election would be available to those enrolled in high-deductible health plans offered through the exchanges. The bill aims to provide individuals with more control over their healthcare spending and savings.
Specifically, the bill stipulates that if an eligible insured elects to receive HSA contributions, they will not be eligible for cost-sharing reductions under the ACA. Instead, the health insurance issuer will make payments to the individual's HSA, with the Secretary of the Treasury reimbursing the issuer for these payments.
Furthermore, the bill includes provisions for public education on the availability of HSA contributions and requires health insurance issuers and exchanges to provide information to prospective enrollees. It also establishes a permanent appropriation for cost-sharing reduction payments and HSA contributions.
Expected Effects
The ACCESS Act, if enacted, would likely lead to a shift in how some individuals enrolled in ACA exchanges manage their healthcare expenses. Some individuals may find the HSA option more appealing, allowing them to save for future medical expenses and potentially lower their overall healthcare costs.
However, it could also lead to some confusion and complexity, as individuals would need to understand the implications of choosing an HSA over cost-sharing reductions. The bill could also impact the risk pool within the exchanges, potentially affecting premiums for other enrollees.
Ultimately, the success of the bill will depend on how well it is implemented and how effectively individuals are educated about their options.
Potential Benefits
- Increased consumer choice: Individuals gain the option to choose between cost-sharing reductions and HSA contributions, potentially tailoring their healthcare coverage to their specific needs.
- Potential for long-term savings: HSA contributions can grow tax-free and be used for future medical expenses, providing a savings vehicle for healthcare.
- Greater control over healthcare spending: Individuals with HSAs have more direct control over how their healthcare dollars are spent.
- Encourages use of high-deductible health plans: By incentivizing HSA contributions, the bill may encourage more people to enroll in high-deductible health plans, potentially lowering premiums for some.
- Public education on HSAs: The bill mandates public education on HSAs, which could increase awareness and understanding of these accounts.
Most Benefited Areas:
Potential Disadvantages
- Complexity and confusion: Individuals may find it difficult to understand the implications of choosing an HSA over cost-sharing reductions, potentially leading to suboptimal decisions.
- Potential for adverse selection: Healthier individuals may be more likely to choose the HSA option, leaving a sicker and more expensive risk pool in the cost-sharing reduction program, potentially driving up premiums.
- Restriction on HSA distributions: The bill restricts distributions from HSAs receiving these contributions to only those made via a qualified medical debit card, which may limit flexibility.
- Administrative burden: Health insurance issuers and exchanges will face additional administrative burdens in implementing the HSA contribution option and providing public education.
- Potential impact on ACA enrollment: The changes could affect enrollment patterns in the ACA exchanges, with uncertain consequences for overall coverage rates.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution (Preamble), as it aims to provide individuals with more affordable healthcare options. It also falls under the powers granted to Congress under Article I, Section 8, which allows Congress to lay and collect taxes, duties, imposts, and excises, to pay the debts and provide for the common defense and general welfare of the United States.
However, the constitutionality of the ACA itself has been challenged, and this bill, as an amendment to the ACA, could also face legal challenges. The specific provisions related to HSA contributions and cost-sharing reductions do not directly implicate any specific constitutional rights or limitations.
Ultimately, the constitutional alignment of the bill depends on the broader interpretation of the general welfare clause and the Commerce Clause, which have been the subject of ongoing debate and litigation.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).