Health Marketplace and Savings Accounts for All Act
- Sponsor
- Sen. Paul, Rand [R-KY]
- Committees
- Finance Committee (primary)
- Last action
- Dec 4, 2025
Bottom line
The bill aims to increase flexibility and access to HSAs and facilitate new group health insurance options through marketplace pools, representing a significant shift towards consumer-driven healthcare.
What it actually does
This bill significantly expands Health Savings Accounts (HSAs) by increasing contribution limits, removing the high-deductible health plan requirement, broadening eligible expenses to include health insurance premiums, direct primary care, vitamins, gym memberships, and fitness trackers, and providing bankruptcy protections. It also creates "Health Marketplace Pools" that are deemed employers under ERISA, allowing them to offer group health plans and insurance coverage, including drug-only plans, to their members.
Proponents argue
Supporters argue that the bill empowers individuals with greater control over their healthcare spending, promotes market-based solutions, and reduces barriers to accessing affordable health insurance and primary care. Expanding HSA eligibility and eligible expenses would make healthcare more accessible and allow individuals to save more for future medical needs. The marketplace pools would create more competitive insurance options, especially for small businesses and individuals.
Opponents contend
Critics might argue that expanding HSAs without the high-deductible requirement could lead to increased healthcare costs if individuals are less incentivized to shop for lower-cost services. The tax benefits of HSAs disproportionately favor higher-income individuals. The marketplace pools could potentially undermine existing insurance markets or lead to less comprehensive coverage if not adequately regulated, and the drug-only plan provision could fragment coverage.
The bill is moderately complex due to its amendments to the Internal Revenue Code and ERISA. An informed reader would need adequate time to understand the implications of these changes, particularly the removal of the HDHP mandate and the creation of health marketplace pools.
Title I, Sec. 102
Increase in HSA Contribution Limitations
This section significantly raises the maximum annual contribution limits for Health Savings Accounts (HSAs). Instead of the current limits tied to high-deductible health plan deductibles, the new limit for individuals would be equal to the applicable dollar amount for elective deferrals to a 401(k) plan (currently $23,000 for 2024, adjusted annually). It also retains and adjusts the additional catch-up contribution for individuals aged 50 or older.
Supporters argue
Supporters argue that higher contribution limits allow individuals to save more for healthcare costs, providing greater financial security and encouraging personal responsibility for health expenditures. It also makes HSAs more attractive as a long-term savings vehicle.
Critics contend
Critics might contend that increasing contribution limits primarily benefits wealthier individuals who can afford to contribute the maximum, exacerbating healthcare disparities and providing a larger tax shelter for those who need it least.
Tradeoffs
Balances the desire to encourage healthcare savings with concerns about tax equity and potential for HSAs to become primarily investment vehicles for the wealthy.
Title I, Sec. 103
Removal of High-Deductible Health Plan Requirement for HSAs
This section fundamentally alters HSA eligibility by striking the requirement that an individual must be covered by a high-deductible health plan (HDHP) to contribute to an HSA. It also removes other related eligibility criteria and conforming amendments. This means any individual can contribute to an HSA, regardless of their health insurance plan type.
Title I, Sec. 104
Expansion of Qualified Medical Expenses to Include Health Insurance Premiums and Direct Primary Care
This section expands the definition of "qualified medical expenses" that can be paid for with HSA funds. It explicitly includes amounts paid for health insurance premiums (except for Medicare supplemental policies) and payments for direct primary care service arrangements (where an individual pays a fixed fee for primary care services). It also allows HSA funds to be used for expenses of a child up to age 27.
Title I, Sec. 108
HSA Coverage for Wellness Expenses
This section further expands the definition of "qualified medical expenses" to include "qualified wellness expenses." These new expenses explicitly cover amounts paid for vitamins, dietary supplements, gym or fitness facility memberships, and wearable fitness trackers.
Title I, Sec. 109
HSA Bankruptcy Protections
This section amends title 11 of the United States Code (Bankruptcy Code) to treat health savings accounts (HSAs) in the same manner as individual retirement accounts (IRAs) for bankruptcy protection purposes. This means HSAs would receive similar protections from creditors during bankruptcy proceedings as retirement funds.
Title II, Sec. 202
Creation of Health Marketplace Pools for Group Health Coverage
This section amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow "health marketplace pools" to be deemed an "employer" for the purpose of offering group health plans or group health insurance coverage. These pools must be formed in good faith to create a risk pool, cannot condition membership on health status, and must offer coverage to all members at rates that may vary subject to non-discrimination rules. They can offer drug-only coverage.
Simplifies employer comparable contribution rules for HSAs, requiring contributions to be the same amount or same percentage of the annual deductible limit (if covered by a health plan), and clarifies rules for part-year and part-time employees.
Sec. 103(b)(11)
Why it matters:Likely standard legislative practice for comprehensive tax code updates, but its impact on employer-sponsored HSA programs is significant.
Case for: Proponents would argue it streamlines administrative burdens for employers offering HSAs, encouraging more employers to offer them by simplifying compliance.
Case against: Critics might argue that simplifying these rules could inadvertently lead to less equitable contributions if not carefully monitored, though the intent is to ensure comparability.
Estimated impact: Reduces administrative complexity for employers, potentially increasing HSA offerings.