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Allows people enrolled through an Exchange in a silver-level high-deductible health plan (HDHP) to choose to receive insurer deposits into their health savings account (HSA) instead of the usual ACA cost-sharing reductions for that month. Insurers who make these HSA deposits are reimbursed by the Treasury, payments are treated as HSA contributions subject to normal HSA rules, and Exchanges and issuers must inform consumers about this option beginning January 1, 2026. The bill defines how to calculate the insurer HSA contribution (an annualized amount equal to the actuarial value of the forgone cost-sharing reduction, prorated monthly), adds conditions on HSA trust distribution (use of a qualified medical debit card while payments are received), treats the payments as advance premium tax credit adjustments for reconciliation, and permanently appropriates the necessary funds for the reimbursement payments for months beginning after December 31, 2025.
The bill shifts some Exchange cost-sharing assistance into insurer-funded HSA deposits—giving low-income enrollees more liquid, tax-advantaged funds and choice—while raising risks of higher point-of-care costs for those without HSA balances, added tax reconciliation complexity, limits on fund flexibility, and modest ongoing federal spending obligations.
Low-income Exchange enrollees eligible for cost-sharing reductions can receive insurer-funded HSA deposits equal to their monthly pro rata CSR amount instead of reduced cost-sharing, increasing liquid funds available to pay medical expenses.
Enrollees (particularly low-income and chronically ill) gain more control over when and how to pay for care because issuer-funded HSAs—reimbursed by Treasury—can be paired with qualified medical debit cards for immediate use on qualified medical expenses.
Issuers and Exchanges must inform prospective enrollees about the HSA-contribution option beginning Jan 1, 2026, improving consumer awareness and enabling better-informed plan choices.
Low-income Exchange enrollees who do not have accessible HSA balances may face higher out-of-pocket costs at the point of care if they opt for HSA deposits instead of immediate reduced cost-sharing, worsening access for those who need care now.
Treating issuer HSA payments as advance premium tax credits increases tax complexity and could trigger annual reconciliation, recapture, or surprise tax liabilities for households.
Restricting HSA distributions during funded months to debit-card‑encoded qualified medical expenses may limit consumer flexibility to use HSA funds for other permitted uses or to reimburse prior qualified expenses.
Introduced February 10, 2025 by W. Greg Steube · Last progress February 10, 2025