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115th Congress    }                                           {   Report
                         HOUSE OF REPRESENTATIVES
 2d Session       }                                           {  115-852

======================================================================




              THE ``PRIMARY CARE ENHANCEMENT ACT OF 2018''

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6317]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6317) to amend the Internal Revenue Code of 1986 to 
provide that direct primary care service arrangements do not 
disqualify deductible health savings account contributions, and 
for other purposes, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.









115th Congress   }                                            {   Report
                         HOUSE OF REPRESENTATIVES
 2d Session      }                                            {  115-852

======================================================================



 
                  PRIMARY CARE ENHANCEMENT ACT OF 2018

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 6317]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6317) to amend the Internal Revenue Code of 1986 to 
provide that direct primary care service arrangements do not 
disqualify deductible health savings account contributions, and 
for other purposes, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
 I.  SUMMARY AND BACKGROUND...........................................4
II. EXPLANATION OF THE BILL...........................................5
          A. Treatment of Direct Primary Care Service 
              Arrangements.......................................     5
III.VOTES OF THE COMMITTEE............................................8

IV.  BUDGET EFFECTS OF THE BILL.......................................8
          A. Committee Estimate of Budgetary Effects.............     8
          B. Statement Regarding New Budget Authority and Tax 
              Expenditures Budget Authority......................    10
          C. Cost Estimate Prepared by the Congressional Budget 
              Office.............................................    10
 V.  OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......10
          A. Committee Oversight Findings and Recommendations....    10
          B. Statement of General Performance Goals and 
              Objectives.........................................    10
          C. Information Relating to Unfunded Mandates...........    10
          D. Applicability of House Rule XXI 5(b)................    11
          E. Tax Complexity Analysis.............................    11
          F. Congressional Earmarks, Limited Tax Benefits, and 
              Limited Tariff Benefits............................    11
          G. Duplication of Federal Programs.....................    11
          H. Disclosure of Directed Rule Makings.................    11
VI.  CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........12
          B. Changes in Existing Law Proposed by the Bill, as 
              Reported...........................................    12

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Primary Care Enhancement Act of 
2018''.

SEC. 2. TREATMENT OF DIRECT PRIMARY CARE SERVICE ARRANGEMENTS.

  (a) In General.--Section 223(c)(1) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new subparagraph:
                  ``(D) Treatment of direct primary care service 
                arrangements.--
                          ``(i) In general.--A direct primary care 
                        service arrangement shall not be treated as a 
                        health plan for purposes of subparagraph 
                        (A)(ii).
                          ``(ii) Direct primary care service 
                        arrangement.--For purposes of this paragraph--
                                  ``(I) In general.--The term `direct 
                                primary care service arrangement' 
                                means, with respect to any individual, 
                                an arrangement under which such 
                                individual is provided medical care (as 
                                defined in section 213(d)) consisting 
                                solely of primary care services (as 
                                defined in section 1833(x)(2)(B) of the 
                                Social Security Act) provided by 
                                primary care practitioners (as defined 
                                in section 1833(x)(2)(A) of the Social 
                                Security Act, determined without regard 
                                to clause (ii) thereof), if the sole 
                                compensation for such care is a fixed 
                                periodic fee.
                                  ``(II) Limitation.--With respect to 
                                any individual for any month, such term 
                                shall not include any arrangement if 
                                the aggregate fees for all direct 
                                primary care service arrangements 
                                (determined without regard to this 
                                subclause) with respect to such 
                                individual for such month exceed $150 
                                (twice such dollar amount in the case 
                                of an individual with any direct 
                                primary care service arrangement (as so 
                                determined) that covers more than one 
                                individual).
                          ``(iii) Certain services specifically 
                        excluded from treatment as primary care 
                        services.--For purposes of this paragraph, the 
                        term `primary care services' shall not 
                        include--
                                  ``(I) procedures that require the use 
                                of general anesthesia,
                                  ``(II) prescription drugs (other than 
                                vaccines), and
                                  ``(III) laboratory services not 
                                typically administered in an ambulatory 
                                primary care setting.
                        The Secretary, after consultation with the 
                        Secretary of Health and Human Services, shall 
                        issue regulations or other guidance regarding 
                        the application of this clause.''.
  (b) Direct Primary Care Service Arrangement Fees Treated as Medical 
Expenses.--Section 223(d)(2)(C) is amended by striking ``or'' at the 
end of clause (iii), by striking the period at the end of clause (iv) 
and inserting ``, or'', and by adding at the end the following new 
clause:
                          ``(v) any direct primary care service 
                        arrangement.''.
  (c) Inflation Adjustment.--Section 223(g)(1) of such Code is 
amended--
          (1) by striking ``and (c)(2)(A)'' each place it appears and 
        inserting ``, (c)(1)(D)(ii)(II), and (c)(2)(A)'', and
          (2) in subparagraph (B), by striking ``clause (ii)'' and 
        inserting ``clauses (ii) and (iii)'' in clause (i), by striking 
        ``and'' at the end of clause (i), by striking the period at the 
        end of clause (ii) and inserting ``, and'', and by inserting 
        after clause (ii) the following new clause:
                          ``(iii) in the case of the dollar amount in 
                        subsection (c)(1)(D)(ii)(II) for taxable years 
                        beginning in calendar years after 2019, 
                        `calendar year 2018'.''
  (d) Reporting of Direct Primary Care Service Arrangement Fees on W-
2.--Section 6051(a) of such Code is amended by striking ``and'' at the 
end of paragraph (16), by striking the period at the end of paragraph 
(17) and inserting ``, and'', and by inserting after paragraph (17) the 
following new paragraph: .
          ``(18) in the case of a direct primary care service 
        arrangement (as defined in section 223(c)(1)(D)(ii)) which is 
        provided in connection with employment, the aggregate fees for 
        such arrangement for such employee.''.
  (e) Effective Date.--The amendments made by this section shall apply 
to months beginning after December 31, 2018, in taxable years ending 
after such date.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill H.R. 6317, as reported by the Committee on Ways 
and Means, allows Health Savings Account (HSA)-eligible 
individuals that participate in a direct primary care (DPC) 
arrangement not to lose their HSA eligibility merely because of 
their participation in a DPC. In addition, it allows DPC 
provider fees to be paid for out of HSAs.

                 B. Background and Need for Legislation

    Individuals eligible for HSAs must have a high deductible 
health plan (HDHP) and no other health plan that provides 
coverage for any benefit which is covered under the high 
deductible health plan. Various types of coverage are 
disregarded for this purpose, including coverage for accidents, 
dental care, and vision care.
    DPC offers patients, employers, and health plans direct 
access to primary care and prevention services through a fixed 
fee. This coordinated, patient-centered care setting affords 
the patient more time with their provider and allows providers 
the time to better understand their patients' health needs. 
Under current law, DPC arrangements are viewed as other 
insurance coverage and thus disqualify members from 
contributing to an HSA. This legislation would allow 
individuals to enroll in both DPC arrangements and HDHPs with 
HSAs.

                         C. Legislative History


Background

    H.R. 6317 was introduced on July 10, 2018 and was referred 
to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 6317, the 
``Primary Care Enhancement Act'', on July 12, 2018, and ordered 
the bill, as amended, favorably reported (with a quorum being 
present).

Committee hearings

    The policy issues associated with Health Savings Accounts 
(HSAs) and need for legislative response were discussed at the 
following Ways and Means hearings during the 114th and 115th 
Congresses:
           Full Committee Hearing on the Tax Treatment 
        of Health Care (April 14, 2016)
           Subcommittee on Health Member Day Hearing on 
        Tax-Related Proposals to Improve Health Care (May 17, 
        2016)
           Subcommittee on Health Hearing on Rising 
        Health Insurance Premiums Under the Affordable Care Act 
        (July 12, 2016)
           Subcommittee on Health Hearing on Lowering 
        Costs and Expanding Access to Health Care through 
        Consumer-Directed Health Plans (June 6, 2018)

                      II. EXPLANATION OF THE BILL


        A. Treatment of Direct Primary Care Service Arrangements


                              PRESENT LAW

Health savings accounts

    An individual may establish a health savings account 
(``HSA'') only if the individual is covered under a plan that 
meets the requirements for a high deductible health plan, as 
described below. In general, HSAs provide tax-favored treatment 
for current medical expenses as well as the ability to save on 
a tax-favored basis for future medical expenses. In general, an 
HSA is a tax-exempt trust or custodial account created 
exclusively to pay for the qualified medical expenses of the 
account holder and his or her spouse and dependents.
    Within limits,\1\ contributions to an HSA made by or on 
behalf of an eligible individual are deductible by the 
individual. Contributions to an HSA are excludible from income 
and employment taxes if made by the employer. Earnings in HSAs 
are not taxable. Distributions from an HSA for qualified 
medical expenses are not includible in gross income. 
Distributions from an HSA that are not used for qualified 
medical expenses are includible in gross income and are subject 
to an additional tax of 20 percent. The 20-percent additional 
tax does not apply if the distribution is made after death or 
disability, or after the individual attains the age of Medicare 
eligibility (age 65).
---------------------------------------------------------------------------
    \1\For 2018, the basic limit on annual contributions that can be 
made to an HSA is $3,450 in the case of self-only coverage and $6,900 
in the case of family coverage. (The 2018 limitation for family 
coverage was revised by the IRS to permit taxpayers to disregard the 
$6,850 limitation under the modified inflation adjustment of Pub. L. 
No. 115-97. Rev. Rul. 2018-27, 2018-20 I.R.B. 591, May 14, 2018.) The 
basic annual contributions limits are increased by $1,000 for 
individuals who have attained age 55 by the end of the taxable year 
(referred to as ``catch-up'' contributions).
---------------------------------------------------------------------------

High deductible health plans

    A high deductible health plan is a health plan that has a 
minimum annual deductible of $1,350 (for 2018) for self-only 
coverage and twice this amount for family coverage, and for 
which the sum of the annual deductible and other annual out-of-
pocket expenses (other than premiums) for covered benefits does 
not exceed $6,650 (for 2018) for self-only coverage and twice 
this amount for family coverage.\2\ These dollar thresholds are 
subject to inflation adjustment, based on chained CPI.\3\
---------------------------------------------------------------------------
    \2\Sec. 223(c)(2).
    \3\Sec. 223(g).
---------------------------------------------------------------------------
    An individual who is covered under a high deductible health 
plan is eligible to establish an HSA, provided that while such 
individual is covered under the high deductible health plan, 
the individual is not covered under any health plan that (1) is 
not a high deductible health plan and (2) provides coverage for 
any benefit (subject to certain exceptions) covered under the 
high deductible health plan.\4\
---------------------------------------------------------------------------
    \4\Sec. 223(c)(1).
---------------------------------------------------------------------------
    Various types of coverage are disregarded for this purpose, 
including coverage of any benefit provided by permitted 
insurance, coverage (whether through insurance or otherwise) 
for accidents, disability, dental care, vision care, or long-
term care, as well as certain limited coverage through health 
flexible savings accounts.\5\ Permitted insurance means 
insurance under which substantially all of the coverage 
provided relates to liabilities incurred under workers' 
compensation laws, tort liabilities, liabilities relating to 
ownership or use of property, or such other similar liabilities 
as specified by the Secretary under regulations. Permitted 
insurance also means insurance for a specified disease or 
illness, and insurance paying a fixed amount per day (or other 
period) of hospitalization.\6\
---------------------------------------------------------------------------
    \5\Sec. 223(c)(1)(B).
    \6\Sec. 223(c)(3).
---------------------------------------------------------------------------

Individuals eligible

    Individuals eligible for HSAs are individuals who are 
covered by a high deductible health plan and no other health 
plan that (1) is not a high deductible health plan and (2) 
provides coverage for any benefit which is covered under the 
high deductible health plan. After an individual has attained 
age 65 and becomes enrolled in Medicare benefits, contributions 
cannot be made to the individual's HSA.\7\
---------------------------------------------------------------------------
    \7\See sec. 223(b)(7), as interpreted by Notice 2004-2, 2004-2 
I.R.B. 269 (December 22, 2003), corrected by Announcement 2004-67, 
2004-36 I.R.B. 459 (September 7, 2004).
---------------------------------------------------------------------------

Direct primary care service arrangements

    A direct primary care service arrangement is an arrangement 
under which an individual only pays a monthly fee for direct 
primary care services rather than paying a doctor's fee for 
each visit. A direct primary care service arrangement is 
considered other coverage or insurance for purposes of a high 
deductible health plan, and so an individual covered by such a 
plan and such an arrangement is not eligible to contribute to 
an HSA.
    A direct primary care service arrangement is distinguished 
from a concierge service arrangement under which patients also 
pay a monthly fee which may cover some or all primary care 
services. Under a concierge service arrangement, patients may 
have to pay for additional medical care, and the practice may 
submit claims to insurance and receive reimbursement from 
insurance for its services. (Under a direct primary care 
service arrangement, the practice cannot submit claims to 
insurance or receive reimbursement from insurance for its 
services.) A concierge service arrangement also is treated as 
other coverage or insurance for purposes of a high deductible 
plan, so an individual covered by such a plan and such an 
arrangement is not eligible to contribute to an HSA.

                           REASONS FOR CHANGE

    The Committee believes connecting consumers to their health 
care dollars through consumer-directed health plans, including 
high deductible health plans, reduces health care costs. The 
Committee further believes that HSAs are an important tool used 
in conjunction with high deductible health plans to permit 
consumers to set-aside funds and provide such consumers the 
choice on how to spend those funds to pay for medical care.
    HSA-qualified high deductible health plans may cover 
certain ``preventive services'' before the deductible is met 
without disqualifying HSA participation. However, participating 
in a direct primary care service arrangement that provides 
certain medical care for a fixed fee currently prevents a 
participant from contributing to their HSA or paying the fixed 
fee from his or her HSA. The Committee believes that the rules 
for HSAs should be expanded to permit individuals who 
participate in high deductible health plans to participate in 
direct primary care service arrangements that meet certain 
requirements without impacting those individuals' ability to 
contribute to HSAs or to pay the fixed fees (up to limited 
monthly caps) for such direct primary care services from their 
HSA accounts.

                        EXPLANATION OF PROVISION

    Under the provision, a direct primary care service 
arrangement that meets the relevant requirements is not treated 
as a health plan that would cause an individual to be 
ineligible to contribute to an HSA. For this purpose, a direct 
primary care service arrangement means, with respect to any 
individual, an arrangement under which such individual is 
provided medical care consisting solely of primary care 
services, as defined in the Social Security Act (SSA),\8\ 
provided by primary care practitioners, as defined in the 
SSA\9\ if the sole compensation for such care is a fixed 
periodic fee. With respect to any individual for any month, the 
aggregate fees for all direct primary care service arrangements 
for such individual for such month cannot exceed $150 (in the 
case of an individual with any such arrangement that covers 
more than one individual, twice such dollar amount, or $300). 
These dollar amounts are to be adjusted annually for inflation. 
The term primary care services does not include (1) procedures 
that require the use of general anesthesia, (2) prescription 
drugs other than vaccines (therefore, vaccines are permitted 
primary care services), and (3) laboratory services not 
typically administered in an ambulatory primary care setting 
for which the Secretary of Treasury, after consultation with 
the Secretary of Health and Human Services, shall issue 
regulations or other guidance.
---------------------------------------------------------------------------
    \8\Sec. 1833(x)(2)(B), 42 U.S.C. 13951.
    \9\Sec. 1833(x)(2)(A), 42 U.S.C. 13951 (without regard to clause 
(ii) thereof).
---------------------------------------------------------------------------
    Fees paid for such direct primary care service arrangements 
will be treated as medical expenses (and not the payment of 
insurance). The aggregate fees for direct primary care service 
arrangements provided to an employee in connection with 
employment will be reported on Form W-2.
    Concierge service arrangements that charge amounts to 
patients in addition to the monthly fee and/or submit claims to 
insurance and receive reimbursement from insurance for such 
services are not treated as meeting the relevant requirements 
for a direct primary care service arrangement and therefore 
HDHP covered persons who participate in such concierge service 
arrangements are not individuals eligible to contribute to an 
HSA under the provision.

                             EFFECTIVE DATE

    The provision applies to months beginning after December 
31, 2018, in taxable years ending after such date.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6317, the ``Primary Care Enhancement 
Act,'' on July 12, 2018.
    H.R. 6317 was ordered favorably reported to the House of 
Representatives as amended by an amendment in the nature of a 
substitute offered by Chairman Brady by a roll call vote of 26 
yeas to 12 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................        X   ........  .........  Mr. Neal.........  ........        X   .........
Mr. Johnson....................        X   ........  .........  Mr. Levin........  ........        X   .........
Mr. Nunes......................  ........  ........  .........  Mr. Lewis........  ........        X   .........
Mr. Reichert...................        X   ........  .........  Mr. Doggett......  ........        X   .........
Mr. Roskam.....................        X   ........  .........  Mr. Thompson.....  ........        X   .........
Mr. Buchanan...................        X   ........  .........  Mr. Larson.......  ........        X   .........
Mr. Smith (NE).................        X   ........  .........  Mr. Blumenauer...        X   ........  .........
Ms. Jenkins....................  ........  ........  .........  Mr. Kind.........        X   ........  .........
Mr. Paulsen....................        X   ........  .........  Mr. Pascrell.....  ........        X   .........
Mr. Marchant...................        X   ........  .........  Mr. Crowley......  ........        X   .........
Ms. Black......................        X   ........  .........  Mr. Davis........  ........        X   .........
Mr. Reed.......................        X   ........  .........  Ms. Sanchez......  ........        X   .........
Mr. Kelly......................        X   ........  .........  Mr. Higgins......  ........        X   .........
Mr. Renacci....................        X   ........  .........  Ms. Sewell.......        X   ........  .........
Ms. Noem.......................        X   ........  .........  Ms. DelBene......        X   ........  .........
Mr. Holding....................        X   ........  .........  Ms. Chu..........  ........        X   .........
Mr. Smith (MO).................        X   ........  .........
Mr. Rice.......................        X   ........  .........
Mr. Schweikert.................        X   ........  .........
Ms. Walorski...................        X   ........  .........
Mr. Curbelo....................        X   ........  .........
Mr. Bishop.....................        X   ........  .........
Mr. LaHood.....................        X   ........  .........
Mr. Wenstrup...................        X   ........  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6317, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal fiscal year budget receipts for the period 
2019-2028:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               FISCAL YEARS  [Millions of Dollars]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                            Item                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Permit Direct Primary Care Service Arrangements\1\..........        -46        -69        -78        -93       -115       -144       -185       -258       -349       -471       -402     -1,810
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details do not add to totals due to rounding.


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Estimate includes the following off-budget effects.......        -12        -17        -19        -23        -28        -36        -46        -60        -80       -108        -99       -429
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: The gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that the revenue-reducing tax 
provision involves no new tax expenditure.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6138, as 
reported. As of the filing of this report, the Committee had 
not received an estimate prepared by the Congressional Budget 
Office (CBO).

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated into 
the description portions of this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                D. Applicability of House Rule XXI 5(b)

    Rule XXI 5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    Section 4022(b) of the Internal Revenue Service 
Restructuring and Reform Act of 1998 (``IRS Reform Act'') 
requires the staff of the Joint Committee on Taxation (in 
consultation with the Internal Revenue Service and the Treasury 
Department) to provide a tax complexity analysis. The 
complexity analysis is required for all legislation reported by 
the Senate Committee on Finance, the House Committee on Ways 
and Means, or any committee of conference if the legislation 
includes a provision that directly or indirectly amends the 
Internal Revenue Code of 1986 and has widespread applicability 
to individuals or small businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code of 1986 and that have ``widespread applicability'' to 
individuals or small businesses, within the meaning of the 
rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(c)(5) of rule XIII of the Rules 
of the House of Representatives, the Committee states that no 
provision of the bill establishes or reauthorizes: (1) a 
program of the Federal Government known to be duplicative of 
another Federal program, (2) a program included in any report 
from the Government Accountability Office to Congress pursuant 
to section 21 of Public 111-139, or (3) a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance, published pursuant to section 6104 of 
title 31, United States Code.

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), 
the following statement is made concerning directed rule 
makings: The Committee advises that the bill requires no 
directed rule makings within the meaning of such section.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED


      B. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986



           *       *       *       *       *       *       *
Subtitle A--Income Taxes

           *       *       *       *       *       *       *


CHAPTER 1--NORMAL TAXES AND SURTAXES

           *       *       *       *       *       *       *


Subchapter B--Computation of Taxable Income

           *       *       *       *       *       *       *


PART VII--ADDITIONAL ITEMIZED DEDUCTIONS FOR INDIVIDUALS

           *       *       *       *       *       *       *


SEC. 223. HEALTH SAVINGS ACCOUNTS.

  (a) Deduction allowed.--In the case of an individual who is 
an eligible individual for any month during the taxable year, 
there shall be allowed as a deduction for the taxable year an 
amount equal to the aggregate amount paid in cash during such 
taxable year by or on behalf of such individual to a health 
savings account of such individual.
  (b) Limitations.--
          (1) In general.--The amount allowable as a deduction 
        under subsection (a) to an individual for the taxable 
        year shall not exceed the sum of the monthly 
        limitations for months during such taxable year that 
        the individual is an eligible individual.
          (2) Monthly limitation.--The monthly limitation for 
        any month is \1/12\ of--
                  (A) in the case of an eligible individual who 
                has self- only coverage under a high deductible 
                health plan as of the first day of such month, 
                $2,250.
                  (B) in the case of an eligible individual who 
                has family coverage under a high deductible 
                health plan as of the first day of such month, 
                $4,500.
          (3) Additional contributions for individuals 55 or 
        older.--
                  (A) In general.--In the case of an individual 
                who has attained age 55 before the close of the 
                taxable year, the applicable limitation under 
                subparagraphs (A) and (B) of paragraph (2) 
                shall be increased by the additional 
                contribution amount.
                  (B) Additional contribution amount.--For 
                purposes of this section, the additional 
                contribution amount is the amount determined in 
                accordance with the following table:


 
------------------------------------------------------------------------
                                     The additional contribution amount
  For taxable years beginning in:                    is:
------------------------------------------------------------------------
2004                                $500
2005                                $600
2006                                $700
2007                                $800
2008                                $900
2009 and thereafter                 $1,000.
------------------------------------------------------------------------

          (4) Coordination with other contributions.--The 
        limitation which would (but for this paragraph) apply 
        under this subsection to an individual for any taxable 
        year shall be reduced (but not below zero) by the sum 
        of--
                  (A) the aggregate amount paid for such 
                taxable year to Archer MSAs of such individual,
                  (B) the aggregate amount contributed to 
                health savings accounts of such individual 
                which is excludable from the taxpayer's gross 
                income for such taxable year under section 
                106(d) (and such amount shall not be allowed as 
                a deduction under subsection (a)), and
                  (C) the aggregate amount contributed to 
                health savings accounts of such individual for 
                such taxable year under section 408(d)(9) (and 
                such amount shall not be allowed as a deduction 
                under subsection (a)).
        Subparagraph (A) shall not apply with respect to any 
        individual to whom paragraph (5) applies.
          (5) Special rule for married individuals.--In the 
        case of individuals who are married to each other, if 
        either spouse has family coverage--
                  (A) both spouses shall be treated as having 
                only such family coverage (and if such spouses 
                each have family coverage under different 
                plans, as having the family coverage with the 
                lowest annual deductible), and
                  (B) the limitation under paragraph (1) (after 
                the application of subparagraph (A) and without 
                regard to any additional contribution amount 
                under paragraph (3))--
                          (i) shall be reduced by the aggregate 
                        amount paid to Archer MSAs of such 
                        spouses for the taxable year, and
                          (ii) after such reduction, shall be 
                        divided equally between them unless 
                        they agree on a different division.
          (6) Denial of deduction to dependents.--No deduction 
        shall be allowed under this section to any individual 
        with respect to whom a deduction under section 151 is 
        allowable to another taxpayer for a taxable year 
        beginning in the calendar year in which such 
        individual's taxable year begins.
          (7) Medicare eligible individuals.--The limitation 
        under this subsection for any month with respect to an 
        individual shall be zero for the first month such 
        individual is entitled to benefits under title XVIII of 
        the Social Security Act and for each month thereafter.
          (8) Increase in limit for individuals becoming 
        eligible individuals after the beginning of the year.--
                  (A) In general.--For purposes of computing 
                the limitation under paragraph (1) for any 
                taxable year, an individual who is an eligible 
                individual during the last month of such 
                taxable year shall be treated--
                          (i) as having been an eligible 
                        individual during each of the months in 
                        such taxable year, and
                          (ii) as having been enrolled, during 
                        each of the months such individual is 
                        treated as an eligible individual 
                        solely by reason of clause (i), in the 
                        same high deductible health plan in 
                        which the individual was enrolled for 
                        the last month of such taxable year.
                  (B) Failure to maintain high deductible 
                health plan coverage.--
                          (i) In general.--If, at any time 
                        during the testing period, the 
                        individual is not an eligible 
                        individual, then--
                                  (I) gross income of the 
                                individual for the taxable year 
                                in which occurs the first month 
                                in the testing period for which 
                                such individual is not an 
                                eligible individual is 
                                increased by the aggregate 
                                amount of all contributions to 
                                the health savings account of 
                                the individual which could not 
                                have been made but for 
                                subparagraph (A), and
                                  (II) the tax imposed by this 
                                chapter for any taxable year on 
                                the individual shall be 
                                increased by 10 percent of the 
                                amount of such increase.
                          (ii) Exception for disability or 
                        death.--Subclauses (I) and (II) of 
                        clause (i) shall not apply if the 
                        individual ceased to be an eligible 
                        individual by reason of the death of 
                        the individual or the individual 
                        becoming disabled (within the meaning 
                        of section 72(m)(7)).
                          (iii) Testing period.--The term 
                        ``testing period'' means the period 
                        beginning with the last month of the 
                        taxable year referred to in 
                        subparagraph (A) and ending on the last 
                        day of the 12th month following such 
                        month.
  (c) Definitions and special rules.--For purposes of this 
section--
          (1) Eligible individual.--
                  (A) In general.--The term ``eligible 
                individual'' means, with respect to any month, 
                any individual if--
                          (i) such individual is covered under 
                        a high deductible health plan as of the 
                        1st day of such month, and
                          (ii) such individual is not, while 
                        covered under a high deductible health 
                        plan, covered under any health plan--
                                  (I) which is not a high 
                                deductible health plan, and
                                  (II) which provides coverage 
                                for any benefit which is 
                                covered under the high 
                                deductible health plan.
                  (B) Certain coverage disregarded.--
                Subparagraph (A)(ii) shall be applied without 
                regard to--
                          (i) coverage for any benefit provided 
                        by permitted insurance,
                          (ii) coverage (whether through 
                        insurance or otherwise) for accidents, 
                        disability, dental care, vision care, 
                        or long-term care, and
                          (iii) for taxable years beginning 
                        after December 31, 2006, coverage under 
                        a health flexible spending arrangement 
                        during any period immediately following 
                        the end of a plan year of such 
                        arrangement during which unused 
                        benefits or contributions remaining at 
                        the end of such plan year may be paid 
                        or reimbursed to plan participants for 
                        qualified benefit expenses incurred 
                        during such period if--
                                  (I) the balance in such 
                                arrangement at the end of such 
                                plan year is zero, or
                                  (II) the individual is making 
                                a qualified HSA distribution 
                                (as defined in section 106(e)) 
                                in an amount equal to the 
                                remaining balance in such 
                                arrangement as of the end of 
                                such plan year, in accordance 
                                with rules prescribed by the 
                                Secretary.
                  (C) Special rule for individuals eligible for 
                certain veterans benefits.--An individual shall 
                not fail to be treated as an eligible 
                individual for any period merely because the 
                individual receives hospital care or medical 
                services under any law administered by the 
                Secretary of Veterans Affairs for a service-
                connected disability (within the meaning of 
                section 101(16) of title 38, United States 
                Code).
                  (D) Treatment of direct primary care service 
                arrangements.--
                          (i) In general.--A direct primary 
                        care service arrangement shall not be 
                        treated as a health plan for purposes 
                        of subparagraph (A)(ii).
                          (ii) Direct primary care service 
                        arrangement.--For purposes of this 
                        paragraph--
                                  (I) In general.--The term 
                                ``direct primary care service 
                                arrangement'' means, with 
                                respect to any individual, an 
                                arrangement under which such 
                                individual is provided medical 
                                care (as defined in section 
                                213(d)) consisting solely of 
                                primary care services (as 
                                defined in section 
                                1833(x)(2)(B) of the Social 
                                Security Act) provided by 
                                primary care practitioners (as 
                                defined in section 
                                1833(x)(2)(A) of the Social 
                                Security Act, determined 
                                without regard to clause (ii) 
                                thereof), if the sole 
                                compensation for such care is a 
                                fixed periodic fee.
                                  (II) Limitation.--With 
                                respect to any individual for 
                                any month, such term shall not 
                                include any arrangement if the 
                                aggregate fees for all direct 
                                primary care service 
                                arrangements (determined 
                                without regard to this 
                                subclause) with respect to such 
                                individual for such month 
                                exceed $150 (twice such dollar 
                                amount in the case of an 
                                individual with any direct 
                                primary care service 
                                arrangement (as so determined) 
                                that covers more than one 
                                individual).
                          (iii) Certain services specifically 
                        excluded from treatment as primary care 
                        services.--For purposes of this 
                        paragraph, the term ``primary care 
                        services'' shall not include--
                                  (I) procedures that require 
                                the use of general anesthesia,
                                  (II) prescription drugs 
                                (other than vaccines), and
                                  (III) laboratory services not 
                                typically administered in an 
                                ambulatory primary care 
                                setting.
                        The Secretary, after consultation with 
                        the Secretary of Health and Human 
                        Services, shall issue regulations or 
                        other guidance regarding the 
                        application of this clause.
          (2) High deductible health plan.--
                  (A) In general.--The term ``high deductible 
                health plan'' means a health plan--
                          (i) which has an annual deductible 
                        which is not less than--
                                  (I) $1,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage, and
                          (ii) the sum of the annual deductible 
                        and the other annual out-of-pocket 
                        expenses required to be paid under the 
                        plan (other than for premiums) for 
                        covered benefits does not exceed--
                                  (I) $5,000 for self-only 
                                coverage, and
                                  (II) twice the dollar amount 
                                in subclause (I) for family 
                                coverage.
                  (B) Exclusion of certain plans.--Such term 
                does not include a health plan if substantially 
                all of its coverage is coverage described in 
                paragraph (1)(B).
                  (C) Safe harbor for absence of preventive 
                care deductible.--A plan shall not fail to be 
                treated as a high deductible health plan by 
                reason of failing to have a deductible for 
                preventive care (within the meaning of section 
                1861 of the Social Security Act, except as 
                otherwise provided by the Secretary).
                  (D) Special rules for network plans.--In the 
                case of a plan using a network of providers--
                          (i) Annual out-of-pocket 
                        limitation.--Such plan shall not fail 
                        to be treated as a high deductible 
                        health plan by reason of having an out-
                        of-pocket limitation for services 
                        provided outside of such network which 
                        exceeds the applicable limitation under 
                        subparagraph (A)(ii).
                          (ii) Annual deductible.--Such plan's 
                        annual deductible for services provided 
                        outside of such network shall not be 
                        taken into account for purposes of 
                        subsection (b)(2).
          (3) Permitted insurance.--The term ``permitted 
        insurance'' means--
                  (A) insurance if substantially all of the 
                coverage provided under such insurance relates 
                to--
                          (i) liabilities incurred under 
                        workers' compensation laws,
                          (ii) tort liabilities,
                          (iii) liabilities relating to 
                        ownership or use of property, or
                          (iv) such other similar liabilities 
                        as the Secretary may specify by 
                        regulations,
                  (B) insurance for a specified disease or 
                illness, and
                  (C) insurance paying a fixed amount per day 
                (or other period) of hospitalization.
          (4) Family coverage.--The term ``family coverage'' 
        means any coverage other than self-only coverage.
          (5) Archer MSA.--The term ``Archer MSA'' has the 
        meaning given such term in section 220(d).
  (d) Health savings account.--For purposes of this section--
          (1) In general.--The term ``health savings account'' 
        means a trust created or organized in the United States 
        as a health savings account exclusively for the purpose 
        of paying the qualified medical expenses of the account 
        beneficiary, but only if the written governing 
        instrument creating the trust meets the following 
        requirements:
                  (A) Except in the case of a rollover 
                contribution described in subsection (f)(5) or 
                section 220(f)(5), no contribution will be 
                accepted--
                          (i) unless it is in cash, or
                          (ii) to the extent such contribution, 
                        when added to previous contributions to 
                        the trust for the calendar year, 
                        exceeds the sum of--
                                  (I) the dollar amount in 
                                effect under subsection 
                                (b)(2)(B), and
                                  (II) the dollar amount in 
                                effect under subsection 
                                (b)(3)(B).
                  (B) The trustee is a bank (as defined in 
                section 408(n)), an insurance company (as 
                defined in section 816), or another person who 
                demonstrates to the satisfaction of the 
                Secretary that the manner in which such person 
                will administer the trust will be consistent 
                with the requirements of this section.
                  (C) No part of the trust assets will be 
                invested in life insurance contracts.
                  (D) The assets of the trust will not be 
                commingled with other property except in a 
                common trust fund or common investment fund.
                  (E) The interest of an individual in the 
                balance in his account is nonforfeitable.
          (2) Qualified medical expenses.--
                  (A) In general.--The term ``qualified medical 
                expenses'' means, with respect to an account 
                beneficiary, amounts paid by such beneficiary 
                for medical care (as defined in section 213(d)) 
                for such individual, the spouse of such 
                individual, and any dependent (as defined in 
                section 152, determined without regard to 
                subsections (b)(1), (b)(2), and (d)(1)(B) 
                thereof) of such individual, but only to the 
                extent such amounts are not compensated for by 
                insurance or otherwise. Such term shall include 
                an amount paid for medicine or a drug only if 
                such medicine or drug is a prescribed drug 
                (determined without regard to whether such drug 
                is available without a prescription) or is 
                insulin.
                  (B) Health insurance may not be purchased 
                from account.--Subparagraph (A) shall not apply 
                to any payment for insurance.
                  (C) Exceptions.--Subparagraph (B) shall not 
                apply to any expense for coverage under--
                          (i) a health plan during any period 
                        of continuation coverage required under 
                        any Federal law,
                          (ii) a qualified long-term care 
                        insurance contract (as defined in 
                        section 7702B(b)),
                          (iii) a health plan during a period 
                        in which the individual is receiving 
                        unemployment compensation under any 
                        Federal or State law, [or]
                          (iv) in the case of an account 
                        beneficiary who has attained the age 
                        specified in section 1811 of the Social 
                        Security Act, any health insurance 
                        other than a medicare supplemental 
                        policy (as defined in section 1882 of 
                        the Social Security Act)[.], or
                          (v) any direct primary care service 
                        arrangement.
          (3) Account beneficiary.--The term ``account 
        beneficiary'' means the individual on whose behalf the 
        health savings account was established.
          (4) Certain rules to apply.--Rules similar to the 
        following rules shall apply for purposes of this 
        section:
                  (A) Section 219(d)(2) (relating to no 
                deduction for rollovers).
                  (B) Section 219(f)(3) (relating to time when 
                contributions deemed made).
                  (C) Except as provided in section 106(d), 
                section 219(f)(5) (relating to employer 
                payments).
                  (D) Section 408(g) (relating to community 
                property laws).
                  (E) Section 408(h) (relating to custodial 
                accounts).
  (e) Tax treatment of accounts.--
          (1) In general.--A health savings account is exempt 
        from taxation under this subtitle unless such account 
        has ceased to be a health savings account. 
        Notwithstanding the preceding sentence, any such 
        account is subject to the taxes imposed by section 511 
        (relating to imposition of tax on unrelated business 
        income of charitable, etc. organizations).
          (2) Account terminations.--Rules similar to the rules 
        of paragraphs (2) and (4) of section 408(e) shall apply 
        to health savings accounts, and any amount treated as 
        distributed under such rules shall be treated as not 
        used to pay qualified medical expenses.
  (f) Tax treatment of distributions.--
          (1) Amounts used for qualified medical expenses.--Any 
        amount paid or distributed out of a health savings 
        account which is used exclusively to pay qualified 
        medical expenses of any account beneficiary shall not 
        be includible in gross income.
          (2) Inclusion of amounts not used for qualified 
        medical expenses.--Any amount paid or distributed out 
        of a health savings account which is not used 
        exclusively to pay the qualified medical expenses of 
        the account beneficiary shall be included in the gross 
        income of such beneficiary.
          (3) Excess contributions returned before due date of 
        return.--
                  (A) In general.--If any excess contribution 
                is contributed for a taxable year to any health 
                savings account of an individual, paragraph (2) 
                shall not apply to distributions from the 
                health savings accounts of such individual (to 
                the extent such distributions do not exceed the 
                aggregate excess contributions to all such 
                accounts of such individual for such year) if--
                          (i) such distribution is received by 
                        the individual on or before the last 
                        day prescribed by law (including 
                        extensions of time) for filing such 
                        individual's return for such taxable 
                        year, and
                          (ii) such distribution is accompanied 
                        by the amount of net income 
                        attributable to such excess 
                        contribution.
                Any net income described in clause (ii) shall 
                be included in the gross income of the 
                individual for the taxable year in which it is 
                received.
                  (B) Excess contribution.--For purposes of 
                subparagraph (A), the term ``excess 
                contribution'' means any contribution (other 
                than a rollover contribution described in 
                paragraph (5) or section 220(f)(5)) which is 
                neither excludable from gross income under 
                section 106(d) nor deductible under this 
                section.
          (4) Additional tax on distributions not used for 
        qualified medical expenses.--
                  (A) In general.--The tax imposed by this 
                chapter on the account beneficiary for any 
                taxable year in which there is a payment or 
                distribution from a health savings account of 
                such beneficiary which is includible in gross 
                income under paragraph (2) shall be increased 
                by 20 percent of the amount which is so 
                includible.
                  (B) Exception for disability or death.--
                Subparagraph (A) shall not apply if the payment 
                or distribution is made after the account 
                beneficiary becomes disabled within the meaning 
                of section 72(m)(7) or dies.
                  (C) Exception for distributions after 
                medicare eligibility.--Subparagraph (A) shall 
                not apply to any payment or distribution after 
                the date on which the account beneficiary 
                attains the age specified in section 1811 of 
                the Social Security Act.
          (5) Rollover contribution.--An amount is described in 
        this paragraph as a rollover contribution if it meets 
        the requirements of subparagraphs (A) and (B).
                  (A) In general.--Paragraph (2) shall not 
                apply to any amount paid or distributed from a 
                health savings account to the account 
                beneficiary to the extent the amount received 
                is paid into a health savings account for the 
                benefit of such beneficiary not later than the 
                60th day after the day on which the beneficiary 
                receives the payment or distribution.
                  (B) Limitation.--This paragraph shall not 
                apply to any amount described in subparagraph 
                (A) received by an individual from a health 
                savings account if, at any time during the 1-
                year period ending on the day of such receipt, 
                such individual received any other amount 
                described in subparagraph (A) from a health 
                savings account which was not includible in the 
                individual's gross income because of the 
                application of this paragraph.
          (6) Coordination with medical expense deduction.--For 
        purposes of determining the amount of the deduction 
        under section 213, any payment or distribution out of a 
        health savings account for qualified medical expenses 
        shall not be treated as an expense paid for medical 
        care.
          (7) Transfer of account incident to divorce.--The 
        transfer of an individual's interest in a health 
        savings account to an individual's spouse or former 
        spouse under a divorce or separation instrument 
        described in clause (i) of section 121(d)(3)(C) shall 
        not be considered a taxable transfer made by such 
        individual notwithstanding any other provision of this 
        subtitle, and such interest shall, after such transfer, 
        be treated as a health savings account with respect to 
        which such spouse is the account beneficiary.
          (8) Treatment after death of account beneficiary.--
                  (A) Treatment if designated beneficiary is 
                spouse.--If the account beneficiary's surviving 
                spouse acquires such beneficiary's interest in 
                a health savings account by reason of being the 
                designated beneficiary of such account at the 
                death of the account beneficiary, such health 
                savings account shall be treated as if the 
                spouse were the account beneficiary.
                  (B) Other cases.--
                          (i) In general.--If, by reason of the 
                        death of the account beneficiary, any 
                        person acquires the account 
                        beneficiary's interest in a health 
                        savings account in a case to which 
                        subparagraph (A) does not apply--
                                  (I) such account shall cease 
                                to be a health savings account 
                                as of the date of death, and
                                  (II) an amount equal to the 
                                fair market value of the assets 
                                in such account on such date 
                                shall be includible if such 
                                person is not the estate of 
                                such beneficiary, in such 
                                person's gross income for the 
                                taxable year which includes 
                                such date, or if such person is 
                                the estate of such beneficiary, 
                                in such beneficiary's gross 
                                income for the last taxable 
                                year of such beneficiary.
                          (ii) Special rules.--
                                  (I) Reduction of inclusion 
                                for predeath expenses.--The 
                                amount includible in gross 
                                income under clause (i) by any 
                                person (other than the estate) 
                                shall be reduced by the amount 
                                of qualified medical expenses 
                                which were incurred by the 
                                decedent before the date of the 
                                decedent's death and paid by 
                                such person within 1 year after 
                                such date.
                                  (II) Deduction for estate 
                                taxes.--An appropriate 
                                deduction shall be allowed 
                                under section 691(c) to any 
                                person (other than the decedent 
                                or the decedent's spouse) with 
                                respect to amounts included in 
                                gross income under clause (i) 
                                by such person.
  (g) Cost-of-living adjustment.--
          (1) In general.--Each dollar amount in subsections 
        (b)(2) [and (c)(2)(A)], (c)(1)(D)(ii)(II), and 
        (c)(2)(A) shall be increased by an amount equal to--
                  (A) such dollar amount, multiplied by
                  (B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in 
                which such taxable year begins determined by 
                substituting for ``calendar year 2016'' in 
                subparagraph (A)(ii) thereof--
                          (i) except as provided in [clause 
                        (ii)] clauses (ii) and (iii), 
                        ``calendar year 1997'', [and]
                          (ii) in the case of each dollar 
                        amount in subsection (c)(2)(A), 
                        ``calendar year 2003''[.], and
                          (iii) in the case of the dollar 
                        amount in subsection (c)(1)(D)(ii)(II) 
                        for taxable years beginning in calendar 
                        years after 2019, ``calendar year 
                        2018''.
        In the case of adjustments made for any taxable year 
        beginning after 2007, section 1(f)(4) shall be applied 
        for purposes of this paragraph by substituting ``March 
        31'' for ``August 31'', and the Secretary shall publish 
        the adjusted amounts under subsections (b)(2) [and 
        (c)(2)(A)], (c)(1)(D)(ii)(II), and (c)(2)(A) for 
        taxable years beginning in any calendar year no later 
        than June 1 of the preceding calendar year.
          (2) Rounding.--If any increase under paragraph (1) is 
        not a multiple of $50, such increase shall be rounded 
        to the nearest multiple of $50.
  (h) Reports.--The Secretary may require--
          (1) the trustee of a health savings account to make 
        such reports regarding such account to the Secretary 
        and to the account beneficiary with respect to 
        contributions, distributions, the return of excess 
        contributions, and such other matters as the Secretary 
        determines appropriate, and
          (2) any person who provides an individual with a high 
        deductible health plan to make such reports to the 
        Secretary and to the account beneficiary with respect 
        to such plan as the Secretary determines appropriate.
The reports required by this subsection shall be filed at such 
time and in such manner and furnished to such individuals at 
such time and in such manner as may be required by the 
Secretary.

           *       *       *       *       *       *       *


Subtitle F--Procedure and Administration

           *       *       *       *       *       *       *


CHAPTER 61--INFORMATION AND RETURNS

           *       *       *       *       *       *       *


Subchapter A--Returns and Records

           *       *       *       *       *       *       *


PART III--INFORMATION RETURNS

           *       *       *       *       *       *       *


Subpart C--Information Regarding Wages Paid Employees

           *       *       *       *       *       *       *


SEC. 6051. RECEIPTS FOR EMPLOYEES.

  (a) Requirement.--Every person required to deduct and 
withhold from an employee a tax under section 3101 or 3402, or 
who would have been required to deduct and withhold a tax under 
section 3402 (determined without regard to subsection (n)) if 
the employee had claimed no more than one withholding 
exemption, or every employer engaged in a trade or business who 
pays remuneration for services performed by an employee, 
including the cash value of such remuneration paid in any 
medium other than cash, shall furnish to each such employee in 
respect of the remuneration paid by such person to such 
employee during the calendar year, on or before January 31 of 
the succeeding year, or, if his employment is terminated before 
the close of such calendar year, within 30 days after the date 
of receipt of a written request from the employee if such 30-
day period ends before January 31, a written statement showing 
the following:
          (1) the name of such person,
          (2) the name of the employee (and an identifying 
        number for the employee if wages as defined in section 
        3121(a) have been paid),
          (3) the total amount of wages as defined in section 
        3401(a),
          (4) the total amount deducted and withheld as tax 
        under section 3402,
          (5) the total amount of wages as defined in section 
        3121(a),
          (6) the total amount deducted and withheld as tax 
        under section 3101,
          (8) the total amount of elective deferrals (within 
        the meaning of section 402(g)(3)) and compensation 
        deferred under section 457, including the amount of 
        designated Roth contributions (as defined in section 
        402A),
          (9) the total amount incurred for dependent care 
        assistance with respect to such employee under a 
        dependent care assistance program described in section 
        129(d),
          (10) in the case of an employee who is a member of 
        the Armed Forces of the United States, such employee's 
        earned income as determined for purposes of section 32 
        (relating to earned income credit),
          (11) the amount contributed to any Archer MSA (as 
        defined in section 220(d)) of such employee or such 
        employee's spouse,
          (12) the amount contributed to any health savings 
        account (as defined in section 223(d)) of such employee 
        or such employee's spouse,
          (13) the total amount of deferrals for the year under 
        a nonqualified deferred compensation plan (within the 
        meaning of section 409A(d)),
          (14) the aggregate cost (determined under rules 
        similar to the rules of section 4980B(f)(4)) of 
        applicable employer-sponsored coverage (as defined in 
        section 4980I(d)(1)), except that this paragraph shall 
        not apply to--
                  (A) coverage to which paragraphs (11) and 
                (12) apply, or
                  (B) the amount of any salary reduction 
                contributions to a flexible spending 
                arrangement (within the meaning of section 
                125),
          (15) the total amount of permitted benefit (as 
        defined in section 9831(d)(3)(C)) for the year under a 
        qualified small employer health reimbursement 
        arrangement (as defined in section 9831(d)(2)) with 
        respect to the employee,
          (16) the amount includible in gross income under 
        subparagraph (A) of section 83(i)(1) with respect to an 
        event described in subparagraph (B) of such section 
        which occurs in such calendar year, [and]
          (17) the aggregate amount of income which is being 
        deferred pursuant to elections under section 83(i), 
        determined as of the close of the calendar year[.], and
          (18) in the case of a direct primary care service 
        arrangement (as defined in section 223(c)(1)(D)(ii)) 
        which is provided in connection with employment, the 
        aggregate fees for such arrangement for such employee.
In the case of compensation paid for service as a member of a 
uniformed service, the statement shall show, in lieu of the 
amount required to be shown by paragraph (5), the total amount 
of wages as defined in section 3121(a), computed in accordance 
with such section and section 3121(i)(2). In the case of 
compensation paid for service as a volunteer or volunteer 
leader within the meaning of the Peace Corps Act, the statement 
shall show, in lieu of the amount required to be shown by 
paragraph (5), the total amount of wages as defined in section 
3121(a), computed in accordance with such section and section 
3121(i)(3). In the case of tips received by an employee in the 
course of his employment, the amounts required to be shown by 
paragraphs (3) and (5) shall include only such tips as are 
included in statements furnished to the employer pursuant to 
section 6053(a). The amounts required to be shown by paragraph 
(5) shall not include wages which are exempted pursuant to 
sections 3101(c) and 3111(c) from the taxes imposed by sections 
3101 and 3111. In the case of the amounts required to be shown 
by paragraph (13), the Secretary may (by regulation) establish 
a minimum amount of deferrals below which paragraph (13) does 
not apply.
  (b) Special Rule as to Compensation of Members of Armed 
Forces.--In the case of compensation paid for service as a 
member of the Armed Forces, the statement required by 
subsection (a) shall be furnished if any tax was withheld 
during the calendar year under section 3402, or if any of the 
compensation paid during such year is includible in gross 
income under chapter 1, or if during the calendar year any 
amount was required to be withheld as tax under section 3101. 
In lieu of the amount required to be shown by paragraph (3) of 
subsection (a), such statement shall show as wages paid during 
the calendar year the amount of such compensation paid during 
the calendar year which is not excluded from gross income under 
chapter 1 (whether or not such compensation constituted wages 
as defined in section 3401(a)).
  (c) Additional Requirements.--The statements required to be 
furnished pursuant to this section in respect of any 
remuneration shall be furnished at such other times, shall 
contain such other information, and shall be in such form as 
the Secretary may by regulations prescribe. The statements 
required under this section shall also show the proportion of 
the total amount withheld as tax under section 3101 which is 
for financing the cost of hospital insurance benefits under 
part A of title XVIII of the Social Security Act.
  (d) Statements to Constitute Information Returns.--A 
duplicate of any statement made pursuant to this section and in 
accordance with regulations prescribed by the Secretary shall, 
when required by such regulations, be filed with the Secretary.
  (e) Railroad Employees.--
          (1) Additional requirement.--Every person required to 
        deduct and withhold tax under section 3201 from an 
        employee shall include on or with the statement 
        required to be furnished such employee under subsection 
        (a) a notice concerning the provisions of this title 
        with respect to the allowance of a credit or refund of 
        the tax on wages imposed by section 3101(b) and the tax 
        on compensation imposed by section 3201 or 3211 which 
        is treated as a tax on wages imposed by section 
        3101(b).
          (2) Information to be supplied to employees.--Each 
        person required to deduct and withhold tax under 
        section 3201 during any year from an employee who has 
        also received wages during such year subject to the tax 
        imposed by section 3101(b) shall, upon request of such 
        employee, furnish to him a written statement showing--
                  (A) the total amount of compensation with 
                respect to which the tax imposed by section 
                3201 was deducted,
                  (B) the total amount deducted as tax under 
                section 3201, and
                  (C) the portion of the total amount deducted 
                as tax under section 3201 which is for 
                financing the cost of hospital insurance under 
                part A of title XVIII of the Social Security 
                Act.
  (f) Statements Required in Case of Sick Pay Paid by Third 
Parties.--
          (1) Statements required from payor.--
                  (A) In general.--If, during any calendar 
                year, any person makes a payment of third-party 
                sick pay to an employee, such person shall, on 
                or before January 15 of the succeeding year, 
                furnish a written statement to the employer in 
                respect of whom such payment was made showing--
                          (i) the name and, if there is 
                        withholding under section 3402(o), the 
                        social security number of such 
                        employee,
                          (ii) the total amount of the third-
                        party sick pay paid to such employee 
                        during the calendar year, and
                          (iii) the total amount (if any) 
                        deducted and withheld from such sick 
                        pay under section 3402.
                For purposes of the preceding sentence, the 
                term ``third-party sick pay'' means any sick 
                pay (as defined in section 3402(o)(2)(C)) which 
                does not constitute wages for purposes of 
                chapter 24 (determined without regard to 
                section 3402(o)(1)).
                  (B) Special rules.--
                          (i) Statements are in lieu of other 
                        reporting requirements.--The reporting 
                        requirements of subparagraph (A) with 
                        respect to any payments shall, with 
                        respect to such payments, be in lieu of 
                        the requirements of subsection (a) and 
                        of section 6041.
                          (ii) Penalties made applicable.--For 
                        purposes of sections 6674 and 7204, the 
                        statements required to be furnished by 
                        subparagraph (A) shall be treated as 
                        statements required under this section 
                        to be furnished to employees.
          (2) Information required to be furnished by 
        employer.--Every employer who receives a statement 
        under paragraph (1)(A) with respect to sick pay paid to 
        any employee during any calendar year shall, on or 
        before January 31 of the succeeding year, furnish a 
        written statement to such employee showing--
                  (A) the information shown on the statement 
                furnished under paragraph (1)(A), and
                  (B) if any portion of the sick pay is 
                excludable from gross income under section 
                104(a)(3), the portion which is not so 
                excludable and the portion which is so 
                excludable.
        To the extent practicable, the information required 
        under the preceding sentence shall be furnished on or 
        with the statement (if any) required under subsection 
        (a).

           *       *       *       *       *       *       *


                             MINORITY VIEWS

                     H.R. 6317 Direct Primary Care

    H.R. 6317 (Paulsen, R-MN and Blumenauer, D-OR) allows 
individuals to contribute to Health Savings Accounts (HSAs) and 
also participate in direct primary care arrangements, which is 
limited in scope of services and capped at $150 per month.
    High Deductible Health Plans (HDHPs) and HSAs do not 
promote healthy behavior. This legislation, which allows 
consumers to have a capitated payment for just primary care, in 
addition to an HDHP, demonstrates why high-deductible health 
plans in their current form do not allow consumers to see value 
in their health insurance. It is widely acknowledged that HSAs 
and HDHPs lead consumers to delay care. They do not encourage 
individuals to make better health care decisions, as 
Republicans' ``skin in the game'' talking points assert. 
Decades of research show that exposure to high out-of-pocket 
costs leads consumers to delay or forgo both necessary and 
unnecessary care. Delaying care and increasing costs run 
counter to Democratic policy goals of better coordinated, high-
value affordable care for American families.
    According to the American Hospital Association, ``Hospitals 
and health systems report that increased enrollment in HDHPs 
over the past several years has reduced access to care and 
subjected patients to costs they cannot afford. In addition, 
patients enrolled in HDHPs appear to delay care until they have 
reached their deductible or are in an emergency situation, 
which could lead to poorer health outcomes.''
    H.R. 6317 does not undo sabotage, premium hikes, and 
benefit cuts Republicans have caused over the past 18 months. 
This bill was one in a series of 11 bills the Committee marked 
up that Republicans claim will help lower health care costs for 
consumers. This legislation does not undo the disruption and 
sabotage Republicans have continued to inflict on the American 
health care system. Instead of focusing on expansion of HSAs 
and HDHPs, Democrats encourage the Committee to redirect its 
attention to legislation that could actually ensure that 
uninsured, low-income, and vulnerable people have real access 
to care. For example H.R. 5155, sponsored by Reps. Pallone, 
Neal, and Scott would protect people with pre-existing 
conditions, help lower premiums for Americans, and improve 
affordability of health coverage.
    Legislation busts the deficit to benefit the wealthy, 
again. Altogether the 11 bills the Committee were marked up 
would add another $92 billion in unoffset tax cuts to the 
deficit. Attempts to expand HSAs (and encourage more enrollment 
in plans with high deductibles, covering very few up-front 
health costs) represent a continuation of Republicans' platform 
of shifting families into health plans that provide fewer 
health benefits and higher out-of-pocket costs--while providing 
greater tax benefits for higher income individuals and 
corporate special interests. According to 2014 Treasury data, 
only five percent of families with adjusted gross income of 
under $100,000 held money in an HSA, and those users' average 
account balances were $1,700.
    HSAs mostly benefit high-income taxpayers while doing 
little to help moderate-income families or the uninsured. High-
income people can best afford to save for health care expenses 
and are therefore the most likely to contribute to HSAs. Higher 
income filers are much more likely to establish HSAs than lower 
income filers--70 percent of HSA contributions come from 
households with incomes over $100,000, according to the Joint 
Commission on Taxation (JCT)--and they are also likelier to max 
out their contributions. Additionally, high-income individuals 
receive the biggest tax benefit for each dollar contributed to 
an HSA, because the value of a tax deduction rises with an 
individual's tax bracket. More than 44 percent of Americans 
can't afford a $400 emergency visit. For these families, it is 
unlikely that they have excess income to devote to a tax 
preferred account.
    JCT estimates the cost of this bill to be $1.8 billion over 
10 years. With this bill, Republicans are adding more tax cuts 
and increasing the deficit. Republicans are using the deficit, 
which they keep making larger with cuts for the wealthy, to 
justify their deep cuts to Medicare and Medicaid. Republicans 
are already proposing to cut Medicare and Medicaid by nearly a 
trillion dollars to try to pay tax cuts they have already 
enacted. This bill will only add fuel to the fire.

                                   Richard E. Neal,
                                           Ranking Member.