Congress quietly expands HSAs while creating new insurance loopholes
S. 3362 — Health Marketplace and Savings Accounts for All Act · Filed by Rand Paul (R-KY) · Introduced Dec 4, 2025 · Referred to committee
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What it does
This bill expands Health Savings Accounts (HSAs) by raising contribution limits, removing the requirement to have a high-deductible health plan, and allowing HSA funds to pay for wellness items like vitamins, gym memberships, and fitness trackers. It also creates 'health marketplace pools'—new entities that can band together to offer group health insurance at lower rates, potentially bypassing some employer-based insurance rules and allowing drug-only coverage plans.
Why we flagged it
The bill's core mechanism is twofold: (1) expanding HSA tax benefits and eligible expenses, and (2) creating a new regulatory carve-out ('health marketplace pools') that allows entities to offer group health insurance outside traditional employer-based frameworks, with reduced nondiscrimination and risk-pooling safeguards.
What the text implies
- Health marketplace pools may allow insurers to segment risk by offering drug-only plans, potentially leaving sicker individuals in higher-cost traditional pools and fragmenting the risk pool.
- The removal of the high-deductible health plan requirement for HSAs could incentivize higher-income individuals to shift to HSAs while leaving traditional insurance pools with older, sicker enrollees.
The full analysis lists 5 implications of this text.
Who stands to gain
high-income individuals with HSAs; health insurance issuers offering group plans through marketplace pools; wellness and fitness companies (gym chains, wearable device makers, supplement manufacturers)