Congress locks in chronic disease coverage for HSA users

What it does

This bill codifies IRS guidance (Notice 2019–45) that allows certain chronic disease management services and items to count as preventive care under high-deductible health plans (HDHPs) paired with health savings accounts (HSAs). The effect is that people with chronic conditions can use HSA funds to pay for these services before meeting their deductible, without penalty—expanding what counts as preventive care and making chronic disease management more affordable for HDHP enrollees.

Why we flagged it

The bill's sole operative function is to codify existing IRS guidance into statute, expanding the definition of preventive care for HDHP/HSA purposes. It is a straightforward consumer-benefit measure with no hidden mechanisms or narrow carve-outs.

What the text implies

• Codification may increase HSA utilization for chronic disease management, potentially shifting some healthcare spending from traditional insurance to tax-advantaged accounts, which could affect insurer revenue models and claims data.
• The bill's reference to 'no inference' language (subsection b) preserves IRS discretion to issue additional guidance on preventive services, preventing the codification from being read as a ceiling on future expansions.
• Chronic disease management services now eligible for pre-deductible HSA spending may increase demand for those services, potentially benefiting providers and vendors of chronic disease management tools.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

People enrolled in HDHPs with HSAs who have chronic conditions gain expanded access to tax-advantaged funds for disease management services, lowering out-of-pocket costs before deductible. The codification removes uncertainty about IRS guidance and locks in a consumer-favorable interpretation of preventive care.

Who stands to gain

• HDHP/HSA enrollees with chronic conditions
• chronic disease management service providers
• HSA custodians and administrators

Named in the bill

Internal Revenue Service (IRS), IRS Notice 2019–45, Internal Revenue Code Section 223(c)(2)(C), high-deductible health plans (HDHPs), health savings accounts (HSAs)

Where it stands

2 cosponsors: 1 Democrats, 1 Republicans.

• Feb 4, 2025 — Introduced · Congress.gov: “Introduced in House”
• Feb 4, 2025 — Referred to House Committee on Ways and Means and Senate Committee on Finance · Congress.gov: “Referred to the House Committee on Ways and Means”
• Mar 4, 2025 — Passed the House · Congress.gov: “Motion to reconsider laid on the table Agreed to without objection”
• Mar 4, 2025 — Floor vote scheduled · Congress.gov: “Mr. Smith (MO) moved to suspend the rules and pass the bill”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

6 lobbying clients named this bill on 9 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $1,050,000 in lobbying spend. A filing names 7 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 82% of bills with at least one filing.

Vern Buchanan, the sponsor, reported $544,700 in PAC receipts in the 2026 cycle.

• Healthequity, Inc. — $660,000 on 1 filing
• American Benefits Council Obo Alliance to Fight for Health Care — $160,000 on 1 filing
• American Benefits Council Obo Alliance to Fight for Health Care — $100,000 on 2 filings
• Wex Health — $50,000 on 1 filing
• American Bankers Association — $40,000 on 2 filings

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.