ACCESS Act

Bill Number

H.R. 1157

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-02-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-02-12T09:06:30Z

AI-Generated Summary

Purpose of the Legislation

The ACCESS Act (H.R. 1157) aims to give individuals buying health insurance through Affordable Care Act (ACA) Exchanges (online marketplaces) the option to redirect government subsidies for lower out-of-pocket costs—known as cost-sharing reductions—into contributions to a Health Savings Account (HSA). An HSA is a tax-advantaged savings account for medical expenses. This choice applies only to high-deductible health plans (HDHPs), which require higher upfront payments before insurance kicks in fully, but allow HSAs.

Key Provisions

• Election Option for HSA Contributions: Eligible individuals (those with household incomes between 100% and 400% of the federal poverty level who qualify for cost-sharing reductions) enrolled in an Exchange HDHP can elect to receive monthly HSA contributions instead of reduced deductibles or copays. The insurer deposits an amount equal to one-twelfth of the annual subsidy value into the individual's HSA, and the government reimburses the insurer.
• HSA Restrictions: Funds in the HSA cannot be withdrawn during the coverage month except via a "qualified medical debit card"—a special debit card issued by a bank that limits use to medical expenses only (like doctor visits or prescriptions).
• Recapture of Excess Payments: If an individual's actual income changes, leading to overpayment of subsidies, the excess is recaptured through tax adjustments, treating HSA contributions as advance payments of the premium tax credit.
• Mandates for Insurers:
• Insurers offering non-HDHP "silver" plans (a coverage level with moderate costs) must also offer an equivalent HDHP option to eligible buyers.
• HDHPs must comply with the HSA contribution rules to qualify as ACA-compliant plans.
• Actuarial value (a measure of how much of average medical costs the plan covers) for HDHPs now includes the value of HSA contributions.
• Public Education Requirement: Starting January 1, 2026, insurers and Exchanges must inform potential enrollees about the HSA option and how to set up and use an HSA.
• Funding: Provides permanent government funding for both traditional cost-sharing reductions and the new HSA contributions, starting after December 31, 2025.
• Effective Date: Applies to coverage months beginning after December 31, 2025.

Significant Changes to Existing Law

• Amendments to Internal Revenue Code (Section 223): Adds a new subsection allowing HSA contributions as an alternative to ACA cost-sharing reductions (under Section 1402 of the ACA), with rules for distributions, recapture, and coordination with HSA contribution limits.
• Amendments to ACA (Section 1301): Requires insurers to offer HDHP alternatives to silver plans and adjusts how HDHPs are evaluated for coverage standards, shifting from direct cost reductions to HSA funding.
• Funding Shift: Makes cost-sharing reduction payments permanent (previously subject to annual appropriations) and extends this to HSA contributions, reducing uncertainty in ACA subsidy funding.
• These changes expand HSA use within the ACA framework without altering eligibility for subsidies or premium tax credits.

Potential Impacts

• On Citizens: Provides more flexibility for eligible individuals to save subsidies in an HSA for future medical needs, potentially lowering taxes on those savings. However, it may limit immediate relief from high out-of-pocket costs, as HSA funds are restricted to medical use via debit card. Low- to moderate-income families could benefit from personalized health spending but might face complexity in electing the option.
• On Government Agencies: The Department of Health and Human Services (HHS) and Treasury Department will handle new reimbursement processes, public education, and oversight of debit cards and recaptures, increasing administrative workload. Permanent appropriations ensure steady funding but could raise long-term federal spending on ACA subsidies.
• On Health Insurance Market: Insurers must expand HDHP offerings, potentially increasing plan variety on Exchanges but requiring system updates for HSA payments and compliance. This could encourage a shift toward consumer-driven health plans.
• On International Relations: No direct impact, as this is a domestic health policy change.

Main Stakeholders Affected

• Eligible Individuals: Low- to moderate-income Americans (100%-400% of federal poverty level) buying individual market insurance through Exchanges, who gain the HSA election choice.
• Health Insurance Issuers: Must offer more HDHPs, process HSA contributions, and provide education, affecting their product lines and administrative costs.
• Government Entities: HHS (overseeing Exchanges and plans), Treasury Department (managing HSAs and tax credits), and state-based Exchanges, which handle implementation and outreach.
• HSA Providers: Banks and trustees issuing qualified medical debit cards and managing accounts, with new restrictions on fund access.
• Healthcare Providers: Indirectly affected if patients use HSAs differently for payments, potentially influencing billing patterns.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Integrates HSAs into the ACA subsidy system without undermining core protections like essential health benefits or nondiscrimination rules. Recapture provisions align with existing tax credit adjustments (under IRC Section 36B), ensuring fiscal accountability. The debit card requirement adds enforcement for qualified medical expenses (as defined in IRC Section 213(d)), preventing misuse.
• Constitutional Implications: None significant; the bill operates within Congress's taxing and spending powers under Article I, enhancing rather than restricting ACA choices.
• Political Implications: Promotes HSAs—a tool often supported for encouraging personal responsibility in healthcare—while preserving ACA subsidies. It could appeal to those favoring market-based alternatives to direct government aid, potentially influencing debates on ACA reforms, but may face opposition from advocates concerned about reduced immediate cost relief for vulnerable populations.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Steube, W. Gregory [R-FL-17]

Cosponsors (3)

Rep. Cammack, Kat [R-FL-3], Rep. Kennedy, Mike [R-UT-3], Rep. Wittman, Robert J. [R-VA-1]

Recent Actions

• 2025-02-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-02-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-02-10: Introduced in House
• 2025-02-10: Introduced in House

Bill Versions

• Affordable Care and Comprehensive Economic Support through Savings Act — issued 2025-02-10 — PDF (8 pages)