HR-8324-119
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, the Judiciary, Armed Services, Veterans' Affairs, and Foreign Affairs, 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.
Sponsored by Eric Burlison (R-MO)
What it does
This bill would make sweeping changes to health savings accounts (HSAs), including raising contribution limits to match 401(k) levels, removing the requirement that account holders be enrolled in a high-deductible health plan, and expanding eligible expenses to include food, vitamins, fitness costs, and health-sharing ministry fees. It would also create "health marketplace pools" allowing unrelated individuals and small groups to band together to purchase group health insurance. Additionally, it would strengthen federal price transparency requirements for hospitals, insurers, labs, and ambulatory surgical centers, and would allow certain experimental drugs to be purchased with HSA funds.
Who benefits
HSA account holders who would gain higher contribution limits and broader eligible expenses. Self-employed individuals and gig workers who currently lack employer-sponsored coverage and could join health marketplace pools. Small business owners who could satisfy the employer coverage mandate with a $450/month HSA contribution. Patients who would gain access to itemized bills and insurer price data. Fitness industry businesses (gyms, equipment retailers, supplement makers) whose products would become HSA-eligible. Health-sharing ministry members who could use HSA funds for ministry fees. Families who could roll over HSA balances to children or parents. Patients with cancer or complex conditions who could access experimental therapies. Individuals who incurred medical expenses before opening an HSA, who could now retroactively apply those costs.
Who is hurt
Hospitals and health systems that would face new, stricter price disclosure mandates and civil monetary penalties for noncompliance. Insurers and pharmacy benefit managers whose negotiated rates would be publicly disclosed. Employers currently satisfying the ACA mandate with comprehensive coverage who may face competitive pressure from the lower-cost $450/month HSA alternative. Workers whose employers shift from comprehensive coverage to HSA-only contributions, potentially leaving them with less predictable coverage. The federal Treasury, which would collect less revenue due to expanded tax deductions. Traditional insurance markets, which could be destabilized if healthier individuals migrate to marketplace pools. Uninsured individuals who cannot afford to fund an HSA even with higher limits.
Supporters argue
Supporters argue that the current HSA system is too restrictive — tying accounts to high-deductible plans and capping contributions well below actual healthcare costs — and that expanding HSAs gives individuals direct control over their healthcare dollars. They contend that hospital price opacity drives up costs for everyone, citing studies showing prices for the same procedure vary by 300–500% across facilities, and that transparency requirements would enable genuine price competition. They further argue that health marketplace pools replicate the risk-pooling benefits of large employer plans for the self-employed and small businesses, a population that has historically faced the highest individual market premiums.
Opponents argue
Opponents argue that expanding HSAs primarily benefits higher-income individuals who can afford to maximize contributions, while doing little for lower-income workers who live paycheck to paycheck and cannot accumulate tax-advantaged savings. They contend that allowing employers to satisfy the coverage mandate with a $450/month HSA contribution — far below average employer plan costs — could incentivize a race to the bottom in employer-sponsored coverage, shifting financial risk onto workers. They further argue that health marketplace pools, by allowing rate variation and operating outside some ACA protections, could siphon healthier enrollees from regulated markets, raising premiums for sicker individuals who remain in traditional plans.
Constitutional context
The bill's tax provisions fall under Congress's broad taxing and spending authority (Art. I, §8, cl. 1) and the Sixteenth Amendment, which permits income taxes without apportionment. Because the bill originates in the House and modifies the Internal Revenue Code, it is consistent with the Origination Clause (Art. I, §7, cl. 1). The employer mandate modification raises no new constitutional questions beyond those already settled in NFIB v. Sebelius (2012), which upheld the ACA's employer provisions.
Checks and balances
Congress would expand executive branch (HHS and IRS) rulemaking authority to implement new transparency standards and HSA rules; checks include notice-and-comment rulemaking requirements, annual compliance reviews by HHS in consultation with the Inspector General, and judicial review of agency enforcement actions.
Historical precedent
The ACA (2010) previously established HSA-compatible high-deductible plan requirements and hospital price transparency rules, which the Trump administration expanded via executive order in 2019; this bill would codify and significantly extend those transparency requirements into statute.