,i #aafth ,,congress #ast ,session ,h4 ,r4 #dfea ,,in ,,the ,,house ,,of ,,representatives ,october #aa1 #bjai,mr4 ,king of ,iowa introduced the following bill2 which was referred to the ,committee on ,ways and ,means ,a ,,bill ,to amend the ,internal ,revenue ,code of #aihf to expand health savings accounts1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,american ,future ,healthcare ,act of #bjai4 #b4 ,reform of ,health ,savings ,accounts 7a7 ,repeal of high deductible health plan requirement ,section #bbc7;a7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7a7 ,deduction allowed ,in the case of an individual1 there shall be allowed as a deduction for a 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 individual4 4 7b7 ,increase in deductible ,,hsa contribution limitations ,section #bbc7;b77#a7 of such ,code is amended by striking the sum of the monthly and all that follows through eligible individual and inserting #aj1jjj 7#bj1jjj in the case of a joint return74 7c7 ,medicare eligible individuals eligible ,to contribute to ,,hsa ,section #bbc7;b7 of such ,code is amended by striking paragraph 7#g74 7d7 ,purchase of health insurance ,section #bbc7;d77#b7 of such ,code is amended-- 7#a7 by striking subparagraphs 7,b7 and 7,c71 and 7#b7 by striking ,qualified medical expenses4-- and all that follows through ,the term and inserting ,qualified medical expenses4--,the term4 7e7 ,cost-of-,living adjustment for catchup contributions ,section #bbc7;f77#a7 of such ,code 7as redesignated by subsection 7g77#c77 is amended by striking ,each dollar amount in subsections 7b77#b7 and 7c77#b77;,a7 and inserting ,in the case of a taxable year beginning after ,december #ca1 #bjai1 each dollar amount in paragraphs 7#a7 and 7#b7 of subsection 7b74 7f7 ,cost-of-,living adjustment indexed to ,,cpi medical care component ,section #bbc7;f7 7as so redesignated7 is amended by adding at the end the following new paragraph3 7#c7 ,,cpi medical care component 7,a7 ,in general ,for purposes of paragraph 7#a71 the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year shall be determined by substituting ,,cpi medical care component for ,,cpi4 7,b7 ,,cpi medical care component ,for purposes of subparagraph 7,a71 the term ,,cpi medical care component means the medical care component for the ,consumer ,price ,index for ,all ,urban ,consumers published by the ,department of ,labor4 4 7g7 ,conforming amendments 7#a7 ,section #bbc7;b7 of such ,code is amended by striking paragraphs 7#b71 7#e71 and 7#h7 and by redesignating paragraphs 7#c71 7#d71 and 7#f7 as paragraphs 7#b71 7#c71 and 7#d71 respectively4 7#b7 ,section #bbc7;b77#c7 of such ,code 7as redesignated by paragraph 7#a77 is amended by striking the last sentence4 7#c7 ,section #bbc of such ,code is amended by striking subsection 7c7 and redesignating subsections 7d7 through 7h7 as subsections 7c7 through 7g71 respectively4 7#d7 ,section #bbc7;c77#a77;,a7 of such ,code 7as redesignated by paragraph 7#c77 is amended-- 7,a7 by striking subsection 7f77#e7 and inserting subsection 7e77#e72 and 7,b7 in clause 7ii7 by striking the sum of-- and all that follows and inserting the dollar amount in effect under subsection 7b77#a744 7#e7 ,section #bbc7;f77#a7 7as redesignated by paragraph 7#c77 is amended by striking calendar year #bjjc and inserting calendar year #bjad4 7#f7 ,section #bf7;b77#b77,u7 of such ,code is amended by striking section #bbc7;f77#d7 and inserting section #bbc7;e77#d74 7#g7 ,sections #ce7;g77#c71 #bbj7;f77#e77;,a71 #hdh7;e77#a77v71 #digc7;a77#e71 and #fjea7;a77#ab7 of such ,code are each amended by striking section #bbc7;d7 each place it appears and inserting section #bbc7;c74 7#h7 ,section #ajf7;d77#a7 of such ,code is amended-- 7,a7 by striking who is an eligible individual 7as defined in section #bbc7;c77#a772 and 7,b7 by striking section #bbc7;d7 and inserting section #bbc7;c74 7#i7 ,section #djh7;d77#i7 of such ,code is amended-- 7,a7 in subparagraph 7,a7 by striking who is an eligible individual 7as defined in section #bbc7;c77 and2 and 7,b7 in subparagraph 7,c7 by striking computed on the basis of the type of coverage under the high deductible health plan covering the individual at the time of the qualified ,,hsa funding distribution4 7#aj7 ,section #hgg;,a7g77#f7 of such ,code is amended by striking #bbc7;f77#d7 and inserting #bbc7;e77#d74 7#aa7 ,section #digc7;g7 of such ,code is amended-- 7,a7 by striking section #bbc7;d7 and inserting section #bbc7;c72 7,b7 in paragraph 7#b71 by striking section #bbc7;f77#b7 and inserting section #bbc7;e77#b72 and 7,c7 by striking section #bbc7;f77#c7 and inserting section #bbc7;e77#c74 7#ab7 ,section #dige of such ,code is amended-- 7,a7 in subsection 7c77#f7-- 7i7 by striking section #bbc7;d7 and inserting section #bbc7;c72 and 7ii7 by striking section #bbc7;e77#b7 and inserting section #bbc7;d77#b72 and 7,b7 in subsection 7e77#a77;,e71 by striking section #bbc7;d7 and inserting section #bbc7;c74 7#ac7 ,section #ffic7;a77#b77;,c7 of such ,code is amended by striking section #bbc7;h7 and inserting section #bbc7;g74 7h7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjah4 #c4 ,,hsa ,rollover to ,medicare ,advantage ,,msa 7a7 ,in general ,section #ach7;b77#b7 of the ,internal ,revenue ,code of #aihf is amended by striking or at the end of subparagraph 7,a71 by adding or at the end of subparagraph 7,c71 and by adding at the end the following new subparagraph3 7,c7 an ,,hsa rollover contribution described in subsection 7d77#e71 4 7b7 ,,hsa rollover contribution ,section #ach7;c7 of such ,code is amended by adding at the end the following new paragraph3 7#e7 ,rollover contribution ,an amount is described in this paragraph as a rollover contribution if it meets the requirement of subparagraphs 7,a7 and 7,b74 7,a7 ,in general ,the requirements of this subparagraph are met in the case of an amount paid or distributed from a health savings to the account beneficiary to the extent the amount is received is paid into a ,medicare ,advantage ,,msa of such beneficiary not later than the #fjth day after the day on which the beneficiary receives the payment or distribution4 7,b7 ,limitation ,this paragraph shall not apply to any amount described in subparagraph 7,a7 received by an individual from a health savings account if1 at any time during the #a-year period ending on the day of such receipt1 such individual received any other amount described in subparagraph 7,a7 from a health savings account which was not includible in the individual's gross income because of the application of section #bbc7;e77#e77;,a74 4 7c7 ,conforming amendment ,section #bbc7;e77#e77;,a7 of such ,code1 as amended by section #b1 is amended by inserting or ,medicare ,advantage ,,msa after into a health savings account4 7d7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjah4 #d4 ,treatment of direct primary care service arrangement fees as medical expense 7a7 ,in general ,section #bbc7;c77#b77;,c7 of the ,internal ,revenue ,code of #aihf1 as amended by the preceding provisions of this ,act1 is amended by striking or at the end of clause 7iii71 by striking the period at the end of clause 7iv7 and inserting 1 or1 and by adding at the end the following new clause3 7v7 any direct primary care service arrangement4 4 7b7 ,direct primary care service arrangement ,section #bbc7;c7 of such ,code1 as amended by the preceding provisions of this ,act1 is amended by redesignating paragraph 7#d7 as paragraph 7#e7 and by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,direct primary care service arrangement ,for purposes of this paragraph-- 7,a7 ,in general ,the term direct primary care service arrangement means1 with respect to any individual1 an arrangement under which such individual is provided medical care 7as defined in section #bac7;d77 consisting solely of primary care services 7as defined in section #ahcc7x77#b77;,b7 of the ,social ,security ,act7 provided by primary care practitioners 7as defined in section #ahcc7x77#b77;,a7 of the ,social ,security ,act1 determined without regard to clause 7ii7 thereof71 if the sole compensation for such care is a fixed periodic fee4 7,b7 ,limitation ,with respect to any individual for any month1 such term shall not include any arrangement if the aggregate fees for all direct primary care service arrangements 7determined without regard to this subclause7 with respect to such individual for such month exceed #aej 7twice such dollar amount in the case of an individual with any direct primary care service arrangement 7as so determined7 that covers more than one individual74 7,c7 ,certain services specifically excluded from treatment as primary care services ,for purposes of this paragraph1 the term primary care services shall not include-- 7i7 procedures that require the use of general anesthesia1 7ii7 prescription drugs 7other than vaccines71 and 7iii7 laboratory services not typically administered in an ambulatory primary care setting4 ,the ,secretary1 after consultation with the ,secretary of ,health and ,human ,services1 shall issue regulations or other guidance regarding the application of this subparagraph4 4 7c7 ,inflation adjustment ,section #bbc7;g77#a7 of such ,code is amended-- 7#a7 by striking and 7c77#b77;,a7 and inserting 1 7c77#b77;,a71 and 7c77#d77;,b71 and 7#b7 in subparagraph 7,b71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii7 in clause 7i71 by striking and at the end of clause 7i71 by striking the period at the end of clause 7ii7 and inserting 1 and1 and by inserting after clause 7ii7 the following new clause3 7iii7 in the case of the dollar amount in subsection 7c77#d77;,b7 for taxable years beginning in calendar years after #bjai1 calendar year #bjah4 4 7d7 ,reporting of direct primary care service arrangement fees on ,w-#b ,section #fjea7;a7 of such ,code is amended by striking and at the end of paragraph 7#af71 by striking the period at the end of paragraph 7#ag7 and inserting 1 and1 and by inserting after paragraph 7#ag7 the following new paragraph3 7#ah7 in the case of a direct primary care service arrangement 7as defined in section #bbc7;c77#d77 which is provided in connection with employment1 the aggregate fees for such arrangement for such employee4 4 7e7 ,effective date ,the amendments made by this subsection shall apply to months beginning after ,december #ca1 #bjah1 in taxable years ending after such date4 #e4 ,allowing certain individuals with alternative health coverage to choose to opt out of the ,medicare part ,a benefit 7a7 ,in general ,any individual described in subsection 7c7 who is otherwise entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act may elect 7in such form and manner as may be specified by the ,commissioner of ,social ,security1 in consultation with the ,secretary of ,health and ,human ,services7 to opt out of such entitlement4 ,notwithstanding any other provision of law1 in the case of an individual who makes such an election1 such individual-- 7#a7 may 7in such form and manner as may be specified by the ,commissioner1 in consultation with the ,secretary7 subsequently choose to end such election and opt back into such entitlement 7in accordance with a process determined by the ,commissioner1 in consultation with the ,secretary7 without1 subject to subsection 7b71 being subject to any penalty2 7#b7 shall not be required to opt out of benefits under title ,,ii of such ,act as a condition for making such election2 and 7#c7 shall not be required to repay any amount paid under such part ,a for items and services furnished prior to making such election4 7b7 ,notification of termination of qualifying alternative health coverage required 7#a7 ,notification ,in the case of an individual who makes an election under subsection 7a7 and whose enrollment in qualifying alternative health coverage is subsequently terminated1 such individual shall notify the ,secretary of ,health and ,human ,services of such termination not later than #fj days after the date of such termination4 7#b7 ,late enrollment penalty ,if an individual required to notify the ,secretary under paragraph 7#a7 fails to provide such notification within the period specified under such paragraph and subsequently chooses to end the election made by such individual under subsection 7a7 and opt back into benefits under part ,a of title ,,xviii of the ,social ,security ,act1 such individual shall be subject to a late enrollment penalty 7as determined by the ,secretary7 in a manner and amount similar to an individual enrolled under such part ,a pursuant to section #ahah of such ,act 7#db ,u4,s4,c4 #acie;i-#b74 7c7 ,individual described 7#a7 ,in general ,for purposes of this section1 an individual described in this subsection is an individual who demonstrates 7in accordance with a process determined by the ,commissioner1 in consultation with the ,secretary7 that the individual is enrolled under qualifying alternative health coverage4 7#b7 ,qualifying alternative health coverage ,for purposes of this section1 the term qualifying alternative health coverage includes a group health plan or health insurance coverage offered in the group or individual market 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia71 or other health coverage specified by the ,commissioner1 in consultation with the ,secretary1 that provides at least benefits comparable to benefits provided under part ,a of title ,,xviii of the ,social ,security ,act4