,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dfea  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #aa1 #bjai,mr4
 ,k+ ( ,i[a introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,ways &    
,means  ,a ,,bill  ,to am5d ! ,int]nal  
,rev5ue ,code ( #aihf to exp& heal?     
sav+s acc\nts1 & = o!r purposes4  #a4   
,%ort title ,?is ,act may be cit$ z !   
,am]ican ,future ,heal?c>e ,act ( #bjai4
  #b4 ,re=m ( ,heal? ,sav+s ,acc\nts    
7a7 ,repeal ( high d$uctible heal? plan 
requirem5t ,section #bbc7;a7 ( !        
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
to read z foll[s3  7a7 ,d$uction all[$  
,9 ! case ( an individual1 !re %all be  
all[$ z a d$uction = a taxable ye> an   
am\nt equal to ! aggregate am\nt paid 9 
ca% dur+ su* taxable ye> by or on behalf
 ( su* individual to a heal? sav+s      
acc\nt ( su* individual4  4  7b7        
,increase 9 d$uctible ,,hsa contribution
 limitations ,section #bbc7;b77#a7 ( su*
 ,code is am5d$ by /rik+ ! sum ( !      
mon?ly & all t foll[s ?r\gh eligible    

individual & ins]t+ #aj1jjj 7#bj1jjj 9 !
 case ( a jo9t return74  7c7 ,m$ic>e    
eligible individuals eligible ,to       
contribute to ,,hsa ,section #bbc7;b7 ( 
su* ,code is am5d$ by /rik+ p>agraph    
7#g74  7d7 ,pur*ase ( heal? insurance   
,section #bbc7;d77#b7 ( su* ,code is    
am5d$-- 7#a7 by /rik+ subp>agraphs 7,b7 
& 7,c71 &  7#b7 by /rik+ ,qualifi$      
m$ical exp5ses4-- & all t foll[s ?r\gh  
,! t]m & ins]t+ ,qualifi$ m$ical        
exp5ses4--,! t]m4  7e7 ,co/-(-,liv+     
adju/m5t = cat*up contributions ,section
 #bbc7;f77#a7 ( su* ,code 7z r$esignat$ 
by subsection 7g77#c77 is am5d$ by /rik+
 ,ea* doll> am\nt 9 subsections 7b77#b7 
& 7c77#b77;,a7 & ins]t+ ,9 ! case ( a   
taxable ye> beg9n+ aft] ,decemb] #ca1   
#bjai1 ea* doll> am\nt 9 p>agraphs 7#a7 
& 7#b7 ( subsection 7b74  7f7           
,co/-(-,liv+ adju/m5t index$ to ,,cpi   
m$ical c>e compon5t ,section #bbc7;f7 7z
 s r$esignat$7 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#c7 ,,cpi     
m$ical c>e compon5t  7,a7 ,9 g5]al ,=   

purposes ( p>agraph 7#a71 ! co/-(-liv+  
adju/m5t det]m9$ "u section #a7;f77#c7 =
 ! cal5d> ye> %all be det]m9$ by        
sub/itut+ ,,cpi m$ical c>e compon5t =   
,,cpi4  7,b7 ,,cpi m$ical c>e compon5t  
,= purposes ( subp>agraph 7,a71 ! t]m   
,,cpi m$ical c>e compon5t means ! m$ical
 c>e compon5t = ! ,consum] ,price ,index
 = ,all ,urban ,consum]s publi%$ by !   
,dep>tm5t ( ,labor4  4  7g7 ,con=m+     
am5dm5ts  7#a7 ,section #bbc7;b7 ( su*  
,code is am5d$ by /rik+ p>agraphs 7#b71 
7#e71 & 7#h7 & by r$esignat+ p>agraphs  
7#c71 7#d71 & 7#f7 z p>agraphs 7#b71    
7#c71 & 7#d71 respectively4  7#b7       
,section #bbc7;b77#c7 ( su* ,code 7z    
r$esignat$ by p>agraph 7#a77 is am5d$ by
 /rik+ ! la/ s5t5ce4  7#c7 ,section #bbc
 ( su* ,code is am5d$ by /rik+          
subsection 7c7 & r$esignat+ subsections 
7d7 ?r\gh 7h7 z subsections 7c7 ?r\gh   
7g71 respectively4  7#d7 ,section       
#bbc7;c77#a77;,a7 ( su* ,code 7z        
r$esignat$ by p>agraph 7#c77 is am5d$-- 
7,a7 by /rik+ subsection 7f77#e7 &      

ins]t+ subsection 7e77#e72 &  7,b7 9    
clause 7ii7 by /rik+ ! sum (-- & all t  
foll[s & ins]t+ ! doll> am\nt 9 effect  
"u subsection 7b77#a744  7#e7 ,section  
#bbc7;f77#a7 7z r$esignat$ by p>agraph  
7#c77 is am5d$ by /rik+ cal5d> ye> #bjjc
 & ins]t+ cal5d> ye> #bjad4  7#f7       
,section #bf7;b77#b77,u7 ( su* ,code is 
am5d$ by /rik+ section #bbc7;f77#d7 &   
ins]t+ section #bbc7;e77#d74  7#g7      
,sections #ce7;g77#c71                  
#bbj7;f77#e77;,a71 #hdh7;e77#a77v71     
#digc7;a77#e71 & #fjea7;a77#ab7 ( su*   
,code are ea* am5d$ by /rik+ section    
#bbc7;d7 ea* place x appe>s & ins]t+    
section #bbc7;c74  7#h7 ,section        
#ajf7;d77#a7 ( su* ,code is am5d$-- 7,a7
 by /rik+ :o is an eligible individual  
7z def9$ 9 section #bbc7;c77#a772 &     
7,b7 by /rik+ section #bbc7;d7 & ins]t+ 
section #bbc7;c74  7#i7 ,section        
#djh7;d77#i7 ( su* ,code is am5d$--     
7,a7 9 subp>agraph 7,a7 by /rik+ :o is  
an eligible individual 7z def9$ 9       
section #bbc7;c77 &2 &  7,b7 9          

subp>agraph 7,c7 by /rik+ comput$ on !  
basis ( ! type ( cov]age "u ! high      
d$uctible heal? plan cov]+ ! individual 
at ! "t ( ! qualifi$ ,,hsa fund+        
di/ribution4  7#aj7 ,section            
#hgg;,a7g77#f7 ( su* ,code is am5d$ by  
/rik+ #bbc7;f77#d7 & ins]t+             
#bbc7;e77#d74  7#aa7 ,section #digc7;g7 
( su* ,code is am5d$--  7,a7 by /rik+   
section #bbc7;d7 & ins]t+ section       
#bbc7;c72  7,b7 9 p>agraph 7#b71 by     
/rik+ section #bbc7;f77#b7 & ins]t+     
section #bbc7;e77#b72 &  7,c7 by /rik+  
section #bbc7;f77#c7 & ins]t+ section   
#bbc7;e77#c74  7#ab7 ,section #dige (   
su* ,code is am5d$--  7,a7 9 subsection 
7c77#f7-- 7i7 by /rik+ section #bbc7;d7 
& ins]t+ section #bbc7;c72 &  7ii7 by   
/rik+ section #bbc7;e77#b7 & ins]t+     
section #bbc7;d77#b72 &  7,b7 9         
subsection 7e77#a77;,e71 by /rik+       
section #bbc7;d7 & ins]t+ section       
#bbc7;c74  7#ac7 ,section               
#ffic7;a77#b77;,c7 ( su* ,code is am5d$ 
by /rik+ section #bbc7;h7 & ins]t+      

section #bbc7;g74  7h7 ,effective date  
,! am5dm5ts made by ?is section %all    
apply to taxable ye>s beg9n+ aft]       
,decemb] #ca1 #bjah4  #c4 ,,hsa ,rollov]
 to ,m$ic>e ,advantage ,,msa  7a7 ,9    
g5]al ,section #ach7;b77#b7 ( ! ,int]nal
 ,rev5ue ,code ( #aihf is am5d$ by /rik+
 or at ! end ( subp>agraph 7,a71 by add+
 or at ! end ( subp>agraph 7,c71 & by   
add+ at ! end ! foll[+ new subp>agraph3 
7,c7 an ,,hsa rollov] contribution      
describ$ 9 subsection 7d77#e71  4  7b7  
,,hsa rollov] contribution ,section     
#ach7;c7 ( su* ,code is am5d$ by add+ at
 ! end ! foll[+ new p>agraph3  7#e7     
,rollov] contribution ,an am\nt is      
describ$ 9 ?is p>agraph z a rollov]     
contribution if x meets ! requirem5t (  
subp>agraphs 7,a7 & 7,b74  7,a7 ,9 g5]al
 ,! requirem5ts ( ?is subp>agraph are   
met 9 ! case ( an am\nt paid or         
di/ribut$ f a heal? sav+s to ! acc\nt   
b5efici>y to ! ext5t ! am\nt is receiv$ 
is paid into a ,m$ic>e ,advantage ,,msa 
( su* b5efici>y n lat] ?an ! #fj? day   

aft] ! day on :i* ! b5efici>y receives !
 paym5t or di/ribution4  7,b7           
,limitation ,?is p>agraph %all n apply  
to any am\nt describ$ 9 subp>agraph 7,a7
 receiv$ by an individual f a heal?     
sav+s acc\nt if1 at any "t dur+ ! #a-ye>
 p]iod end+ on ! day ( su* receipt1 su* 
individual receiv$ any o!r am\nt        
describ$ 9 subp>agraph 7,a7 f a heal?   
sav+s acc\nt :i* 0 n includible 9 !     
individual's gross income because ( !   
application ( section #bbc7;e77#e77;,a74
  4  7c7 ,con=m+ am5dm5t ,section       
#bbc7;e77#e77;,a7 ( su* ,code1 z am5d$  
by section #b1 is am5d$ by ins]t+ or    
,m$ic>e ,advantage ,,msa aft] into a    
heal? sav+s acc\nt4  7d7 ,effective date
 ,! am5dm5ts made by ?is section %all   
apply to taxable ye>s beg9n+ aft]       
,decemb] #ca1 #bjah4  #d4 ,treatm5t (   
direct prim>y c>e s]vice arrangem5t fees
 z m$ical exp5se  7a7 ,9 g5]al ,section 
#bbc7;c77#b77;,c7 ( ! ,int]nal ,rev5ue  
,code ( #aihf1 z am5d$ by ! prec$+      
provisions ( ?is ,act1 is am5d$ by /rik+

 or at ! end ( clause 7iii71 by /rik+ ! 
p]iod at ! end ( clause 7iv7 & ins]t+ 1 
or1 & by add+ at ! end ! foll[+ new     
clause3  7v7 any direct prim>y c>e      
s]vice arrangem5t4  4  7b7 ,direct      
prim>y c>e s]vice arrangem5t ,section   
#bbc7;c7 ( su* ,code1 z am5d$ by !      
prec$+ provisions ( ?is ,act1 is am5d$  
by r$esignat+ p>agraph 7#d7 z p>agraph  
7#e7 & by ins]t+ aft] p>agraph 7#c7 !   
foll[+ new p>agraph3  7#d7 ,direct      
prim>y c>e s]vice arrangem5t ,= purposes
 ( ?is p>agraph-- 7,a7 ,9 g5]al ,! t]m  
direct prim>y c>e s]vice arrangem5t     
means1 ) respect to any individual1 an  
arrangem5t "u :i* su* individual is     
provid$ m$ical c>e 7z def9$ 9 section   
#bac7;d77 consi/+ solely ( prim>y c>e   
s]vices 7z def9$ 9 section              
#ahcc7x77#b77;,b7 ( ! ,social ,security 
,act7 provid$ by prim>y c>e practition]s
 7z def9$ 9 section #ahcc7x77#b77;,a7 ( 
! ,social ,security ,act1 det]m9$ )\t   
reg>d to clause 7ii7 !re(71 if ! sole   
comp5sation = su* c>e is a fix$ p]iodic 

fee4  7,b7 ,limitation ,) respect to any
 individual = any mon?1 su* t]m %all n  
include any arrangem5t if ! aggregate   
fees = all direct prim>y c>e s]vice     
arrangem5ts 7det]m9$ )\t reg>d to ?is   
subclause7 ) respect to su* individual =
 su* mon? exce$ #aej 7twice su* doll>   
am\nt 9 ! case ( an individual ) any    
direct prim>y c>e s]vice arrangem5t 7z s
 det]m9$7 t cov]s m ?an "o individual74 
7,c7 ,c]ta9 s]vices specifically exclud$
 f treatm5t z prim>y c>e s]vices ,=     
purposes ( ?is p>agraph1 ! t]m prim>y   
c>e s]vices %all n include-- 7i7        
proc$ures t require ! use ( g5]al       
ane/hesia1  7ii7 prescription drugs 7o!r
 ?an vacc9es71 &  7iii7 laboratory      
s]vices n typically adm9i/]$ 9 an       
ambulatory prim>y c>e sett+4  ,!        
,secret>y1 aft] consultation ) !        
,secret>y ( ,heal? & ,human ,s]vices1   
%all issue regulations or o!r guidance  
reg>d+ ! application ( ?is subp>agraph4 
4  7c7 ,inflation adju/m5t ,section     
#bbc7;g77#a7 ( su* ,code is am5d$-- 7#a7

 by /rik+ & 7c77#b77;,a7 & ins]t+ 1     
7c77#b77;,a71 & 7c77#d77;,b71 &  7#b7 9 
subp>agraph 7,b71 by /rik+ clause 7ii7 &
 ins]t+ clauses 7ii7 & 7iii7 9 clause   
7i71 by /rik+ & at ! end ( clause 7i71  
by /rik+ ! p]iod at ! end ( clause 7ii7 
& ins]t+ 1 &1 & by ins]t+ aft] clause   
7ii7 ! foll[+ new clause3  7iii7 9 !    
case ( ! doll> am\nt 9 subsection       
7c77#d77;,b7 = taxable ye>s beg9n+ 9    
cal5d> ye>s aft] #bjai1 cal5d> ye>      
#bjah4  4  7d7 ,report+ ( direct prim>y 
c>e s]vice arrangem5t fees on ,w-#b     
,section #fjea7;a7 ( su* ,code is am5d$ 
by /rik+ & at ! end ( p>agraph 7#af71 by
 /rik+ ! p]iod at ! end ( p>agraph 7#ag7
 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph
 7#ag7 ! foll[+ new p>agraph3  7#ah7 9 !
 case ( a direct prim>y c>e s]vice      
arrangem5t 7z def9$ 9 section           
#bbc7;c77#d77 :i* is provid$ 9          
connection ) employm5t1 ! aggregate fees
 = su* arrangem5t = su* employee4  4    
7e7 ,effective date ,! am5dm5ts made by 
?is subsection %all apply to mon?s      

beg9n+ aft] ,decemb] #ca1 #bjah1 9      
taxable ye>s end+ aft] su* date4  #e4   
,all[+ c]ta9 individuals ) alt]native   
heal? cov]age to *oose to opt out ( !   
,m$ic>e "p ,a b5efit  7a7 ,9 g5]al ,any 
individual describ$ 9 subsection 7c7 :o 
is o!rwise entitl$ to b5efits "u "p ,a (
 title ,,xviii ( ! ,social ,security    
,act may elect 79 su* =m & mann] z may  
be specifi$ by ! ,commission] ( ,social 
,security1 9 consultation ) ! ,secret>y 
( ,heal? & ,human ,s]vices7 to opt out (
 su* entitlem5t4 ,not)/&+ any o!r       
provision ( law1 9 ! case ( an          
individual :o makes su* an election1 su*
 individual--  7#a7 may 79 su* =m &     
mann] z may be specifi$ by !            
,commission]1 9 consultation ) !        
,secret>y7 subsequ5tly *oose to end su* 
election & opt back into su* entitlem5t 
79 accordance ) a process det]m9$ by !  
,commission]1 9 consultation ) !        
,secret>y7 )\t1 subject to subsection   
7b71 be+ subject to any p5alty2  7#b7   
%all n be requir$ to opt out ( b5efits  

"u title ,,ii ( su* ,act z a condition =
 mak+ su* election2 &  7#c7 %all n be   
requir$ to repay any am\nt paid "u su*  
"p ,a = items & s]vices furni%$ prior to
 mak+ su* election4  7b7 ,notification (
 t]m9ation ( qualify+ alt]native heal?  
cov]age requir$  7#a7 ,notification ,9 !
 case ( an individual :o makes an       
election "u subsection 7a7 & ^:         
enrollm5t 9 qualify+ alt]native heal?   
cov]age is subsequ5tly t]m9at$1 su*     
individual %all notify ! ,secret>y (    
,heal? & ,human ,s]vices ( su* t]m9ation
 n lat] ?an #fj days aft] ! date ( su*  
t]m9ation4  7#b7 ,late enrollm5t p5alty 
,if an individual requir$ to notify !   
,secret>y "u p>agraph 7#a7 fails to     
provide su* notification )9 ! p]iod     
specifi$ "u su* p>agraph & subsequ5tly  
*ooses to end ! election made by su*    
individual "u subsection 7a7 & opt back 
into b5efits "u "p ,a ( title ,,xviii ( 
! ,social ,security ,act1 su* individual
 %all be subject to a late enrollm5t    
p5alty 7z det]m9$ by ! ,secret>y7 9 a   

mann] & am\nt simil> to an individual   
enroll$ "u su* "p ,a pursuant to section
 #ahah ( su* ,act 7#db ,u4,s4,c4        
#acie;i-#b74  7c7 ,individual describ$  
7#a7 ,9 g5]al ,= purposes ( ?is section1
 an individual describ$ 9 ?is subsection
 is an individual :o demon/rates 79     
accordance ) a process det]m9$ by !     
,commission]1 9 consultation ) !        
,secret>y7 t ! individual is enroll$ "u 
qualify+ alt]native heal? cov]age4  7#b7
 ,qualify+ alt]native heal? cov]age ,=  
purposes ( ?is section1 ! t]m qualify+  
alt]native heal? cov]age includes a gr\p
 heal? plan or heal? insurance cov]age  
(f]$ 9 ! gr\p or individual m>ket 7z su*
 t]ms are def9$ 9 section #bgia ( !     
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia71 or o!r heal?    
cov]age specifi$ by ! ,commission]1 9   
consultation ) ! ,secret>y1 t provides  
at lea/ b5efits comp>able to b5efits    
provid$ "u "p ,a ( title ,,xviii ( !    
,social ,security ,act4