The ACCESS Act would add a new option for people enrolled in Exchange-specific high-deductible health plans (HDHPs): instead of receiving reduced cost-sharing (CSR) for their silver-level plans, eligible enrollees could elect to have their health insurance issuer contribute funds to a health savings account (HSA) for each month. The issuer’s monthly contribution would be matched by payments from the Secretary (Treasury) to the issuer, effectively converting some CSR support into HSA contributions. The act also adjusts ACA and tax rules to ensure HDHPs are offered and integrated with this HSA contribution mechanism, requires public education about the option starting in 2026, and provides funding and recapture rules related to these payments. The goal is to shift some CSR support into HSAs while maintaining alignment with actuarial values and premium subsidy rules. In practical terms, eligible insured individuals could choose monthly HSA contributions equivalent to a portion of what CSR reductions would have provided, with the payments treated as HSA funding and subject to specific restrictions (notably on how the funds can be spent and how distributions are handled). The bill includes coordination with existing premium tax credits and CSR provisions, imposes distribution controls on HSAs that receive these payments, and establishes an effective date for months beginning after December 31, 2025.
Key Points
- 1Creates a new IRC 223(i) mechanism allowing an Exchange-provided HDHP enrollee to elect monthly HSA contributions in lieu of reduced cost-sharing, with the issuer paying into the enrollee’s HSA and the Secretary (Treasury) making matching payments to the issuer.
- 2Defines the annual reduced cost-sharing actuarial equivalent amount and uses it to determine the monthly HSA contribution (1/12 of that amount), with the computation taking household income into account.
- 3Imposes use restrictions on HSAs that receive these payments: distributions must be restricted to medically related charges via a qualified medical debit card (bank-issued, provided by the HSA trustee, and usable only for defined medical expenses); funds must be structured to meet these distribution rules.
- 4Provides a recapture framework: amounts paid into HSAs are treated as advance premium tax credits (PITCs) and the regular premium tax credits are adjusted accordingly to reflect these payments.
- 5Expands ACA rules related to HDHPs and HSAs, requiring insurers to offer actuarially equivalent HDHPs in the silver plan tier and to comply with HSA contribution requirements for such plans; actuarial value calculations must include the impact of HSA contributions.