Ways and Means Advances GOP Health Priorities
July 12, 2018 - The House Ways and Means Committee on Thursday approved seven health tax bills, including one that would roll back parts of the 2010 health care law.
The two-day markup turned into a testy debate over the health care law and steps Republicans took in the past two years to change it. By the time the session ended late Thursday afternoon, the panel had advanced a total of 11 bills designed to expand the use of health savings accounts, a tax-favored account that people with high-deductible health plans use for out-of-pocket medical expenses, as well as other conservative health measures.
Committee Chairman Kevin Brady, R-Texas, told CQ he expects the bills to come to the floor as part of a broader package during the last week of July, though he warned GOP leaders could move that up. That package could also include language to repeal the health law's medical device tax.
Democrats argued that changes to policies affecting health savings accounts only benefit richer Americans and ignore threats to the law’s guaranteed coverage of pre-existing conditions and access to health care. Republicans on the panel countered that expanding the use of health savings accounts would help people deal with rising health costs.
Despite the arguments between the parties, a couple of bipartisan bills were approved Thursday along with five Republican-only measures.
The bipartisan bills approved Thursday would allow Americans to use pretax dollars set aside in health savings accounts and flexible spending accounts to write off more types of medical expenses, such as over-the-counter medications, feminine hygiene products and gym memberships. Those approved measures include:
- A bill (HR 6199) that would reverse a provision of the 2010 health law and make some over-the-counter medical products a qualified expense for HSAs and FSAs without patients first being required to receive a doctor's prescription. The measure advanced 24-10.
- A measure (HR 6312) that would allow consumers to use up to $1,000 in pretax accounts to purchase gym memberships, fitness classes or exercise safety equipment. It advanced 28-7.
The day before, the panel approved three bills (HR 6301, HR 6317 and HR 6305) that all would expand ways a consumer could use an HSA. The panel also advanced a bill (HR 6309) to allow seniors eligible for Medicare Part A inpatient care but who are still working to contribute to an HSA.
The panel also considered several partisan measures related to the 2010 health law and health savings accounts on Thursday, including:
- A measure (HR 4616) by Reps. Devin Nunes, R-Calif., and Mike Kelly, R-Penn., that would retroactively repeal the health care law’s requirement that most employers offer health insurance coverage to employees for 2015, 2016, 2017 and 2018 and further punt the implementation of the so-called “Cadillac tax,” a levy on high-cost employer-sponsored health plans, to the year 2023. The measure, the most expensive of the 11 bills considered this week, at a cost of nearly $40 billion over a decade, advanced along party lines by 22-15.
- Two measures from Reps. Peter Roskam, R-Ill., and Michael C. Burgess, R-Texas. The first (HR 6311) — approved 23-16 — would allow people who qualify for premium tax credits to help purchase health insurance coverage to use those credits to purchase plans sold off of the exchanges and let anyone — not just people under 30 — buy basic catastrophic health coverage. The second (HR 6314) would allow catastrophic health plans to qualify to be paired with an HSA and was approved 23-13.
- A Paulsen bill (HR 6306) to increase the annual contribution limits to HSAs to match the sum of the qualifying health plan’s minimum annual deductible and the allowable out-of-pocket costs. The bill would also allow spousal catch-up contributions and provide a 60-day grace period for qualifying medical expenses that were incurred before a person established their HSA. It was approved 22-16.
- A measure (HR 6313) from Rep. Steve Stivers, R-Ohio, that would allow funds in a flexible spending account to roll over from year-to-year. The measure advanced 22-14.
During the markup, members re-litigated parts of the 2010 health care law (PL 111-148, PL 111-152) but debate also stretched into other areas, including a lengthy back-and-forth on child separation policies and the broader immigration debate that has embroiled the House over the past several weeks.
Committee Democrats railed against the Trump administration’s decision not to defend certain provisions of the health law from a recent legal challenge, after Rep. Lloyd Doggett, D-Texas, introduced an amendment to a bill (HR 6306) by Rep. Erik Paulsen, R-Minn., regarding health savings accounts. The Doggett amendment would have clarified that all plans covered under the Paulsen bill, which would boost the contribution limits for HSAs, must not discriminate or increase premiums for people with pre-existing conditions. That amendment was rejected, 15-23.
Rep. Judy Chu, D-Calif., introduced an amendment to the Paulsen bill that would allow people to use funds in their health savings account to cover medical expenses for children who are in the custody of the Department of Health and Human Services because they were separated from their parents through the Trump administration’s zero tolerance approach. The proposal went down, 16-22.
Rep. Suzan DelBene, D-Wash., offered an amendment to an abortion-related bill (HR 6311). Democrats said the legislation would not allow consumers to use a tax credit to purchase health plans that covered abortion services and that consumers in at least four states that require marketplace plans to cover abortion wouldn’t be able to use that premium assistance. Rep. Kristi Noem, R-S.D., said the bill would apply standard Hyde Amendment language that prohibits federal funding of abortion. The amendment was rejected, 15-22.