Health Savings and Affordability for Fertility Act
- Sponsor
- Rep. Underwood, Lauren [D-IL-14]
- Committees
- Ways and Means Committee (primary)
- Last action
- Apr 30, 2025
Bottom line
This bill expands the types of medical expenses eligible for pre-tax payment through Health Savings Accounts to include a comprehensive range of fertility treatments, aiming to reduce the financial burden on individuals seeking such care.
What it actually does
This bill amends Section 223(d)(2) of the Internal Revenue Code of 1986 to explicitly include a comprehensive list of fertility treatments as qualified medical expenses for Health Savings Accounts (HSAs). This change allows individuals to use pre-tax HSA funds to pay for services such as the preservation of reproductive material, various forms of artificial insemination, assisted reproductive technology (like IVF), prescribed fertility medications, and costs associated with gamete donation.
Proponents argue
Supporters argue that fertility treatments are essential medical care, and their high cost often creates a significant barrier for individuals and couples seeking to build families. Including these treatments as qualified HSA expenses would make them more affordable by allowing individuals to pay with pre-tax dollars, thereby increasing access to care and promoting family formation and reproductive autonomy.
Opponents contend
Critics might argue that expanding the definition of qualified medical expenses for HSAs could lead to a reduction in federal tax revenue, as more individuals would utilize pre-tax funds for these expenses. Some may also contend that HSAs primarily benefit higher-income individuals who can afford to contribute more, potentially exacerbating healthcare disparities rather than alleviating them for all.
The bill is very short and clearly written, making its core provisions and intent easily understandable for any reader in a minimal amount of time.
Section 2(a) of the bill, amending Section 223(d)(2) of the Internal Revenue Code of 1986
Inclusion of Fertility Treatments as Qualified Medical Expenses for HSAs
This provision amends the Internal Revenue Code to explicitly add "fertility treatments" to the list of medical expenses that can be paid for using funds from a Health Savings Account (HSA). It then provides a detailed definition of "fertility treatment," encompassing preservation of human oocytes, sperm, or embryos; artificial insemination; assisted reproductive technology (including in vitro fertilization); medications prescribed for fertility; and gamete donation, including reimbursement for donors and associated medical expenses. This change allows individuals to use pre-tax dollars from their HSA for these services, effectively reducing their out-of-pocket costs.
Supporters argue
Supporters argue that this expansion recognizes fertility care as legitimate and often medically necessary treatment, directly addressing the substantial financial burden faced by many individuals and families. By allowing pre-tax payment, it makes these often-costly procedures more accessible and affordable, aligning with the goal of supporting family planning and reproductive health.
Critics contend
Some may argue that while the intent is beneficial, this change primarily benefits individuals who already have HSAs and sufficient income to contribute to them, potentially not addressing the affordability crisis for lower-income individuals. Concerns about the potential impact on federal tax revenue due to increased tax deductions might also be raised as a trade-off.
Tradeoffs
The bill balances the goal of increasing access to fertility care by reducing out-of-pocket costs for individuals against the potential for reduced federal tax revenue and the argument that HSAs, as tax-advantaged accounts, may disproportionately benefit higher-income earners.
This subsection, titled "No Inference," clarifies that the bill's amendments should not be interpreted to create any inference regarding the tax treatment of fertility-related expenses paid on or before the enactment date. Furthermore, it explicitly states that the amendments do not limit the continued treatment of any fertility-related expense not specifically described in the new definition as a medical expense for HSA purposes after the enactment date.
Section 2(c)
Why it matters:This clause is standard legislative practice designed to prevent unintended legal interpretations or challenges to existing tax treatments. It serves as a protective measure to ensure legal clarity and avoid retroactive application or an inadvertent narrowing of other potentially eligible medical expenses.
Case for: Supporters would argue this clause provides crucial legal clarity and prevents unintended consequences, such as retroactive tax disputes or the exclusion of other legitimate fertility-related medical expenses not explicitly listed in the new definition. It ensures that the bill's scope is precisely understood without negatively impacting prior or future unlisted expenses.
Case against: No strong case against this clause itself, as it is a technical clarification. Some might argue that the need for such specific disclaimers highlights the inherent complexity of the tax code.
Estimated impact: Minimal direct fiscal impact, but significant for legal certainty, preventing potential disputes, and ensuring consistent application of tax law regarding fertility expenses.