As is often the case when legislation is winding its way through Congress, one or two provisions always seem to steal the headlines. Typically, these provisions illicit great controversy, significant opponents, or the potential to create ads for campaign season.
However, there are also legislative provisions that receive far less attention but play a critical role in improving access and affordability for patients—both now and as they grow older. H.R. 1, the “One Big Beautiful Bill Act” (OBBBA) includes legislation that modernizes the functions of Health Savings Accounts (HSAs) so that they work better for workers and their families in large and small businesses alike. If enacted, this will be the first significant overhaul of HSAs since they were created more than 20 years ago. Included in the bill are provisions that:
- Clarify that direct primary care may be offered alongside an HSA.
- Let employees contribute to an HSA even if their spouse has an FSA.
- Permit HSA dollars to be used toward wellness benefits, including exercise and other expenses associated with participating in physical activity.
- Give greater flexibility to offer first-dollar coverage of health services at an onsite employee clinic.
- Allow both spouses 55 and up to make catch-up contributions to a single HSA.
- Convert FSA or HRA balances into HSA contributions when enrolling in a High-Deductible Health Plan (HDHP)-HSA plan.
- Authorizing bronze and catastrophic Affordable Care Act plans to make HSA contributions.
- Allow medical services that occurred within 60 days before opening an HSA account to be eligible for reimbursement.
- Enable working seniors eligible for Medicare Part A and enrolled in HDHPs to contribute to HSAs.
- Allow individuals and families with modest incomes to increase annual contributions to their HSAs.
As the largest provider of private health benefits, employers have a significant stake in developing and implementing innovative, affordable health care options. The “One Big Beautiful Bill Act” is a once-in-a-generation opportunity to transform and strengthen these health savings vehicles so that more than 60 million Americans and their families can better plan for health care expenses. These HSA provisions could make a real difference for Americans and their financial and physical health. We urge Congress to maintain these critical reforms and get them to the President’s desk to be signed into law.