Update: AAFP Should Stand Up for Patient Access to Independent DPC and Withdraw Support for HR 3708

Update: Here is Mr. Shawn Martin’s reply. He granted permission for IP4PI to share it with the understanding that it should not be considered an official statement from the AAFP.

On Oct 25, 2019, at 7:17 AM, Shawn Martin wrote:

Craig-

Thank you for your email. I hope you are doing well. Your email outlines several areas of concern that we share and have been communicating to the various bill sponsors and Committees. We are working to make changes to the bill and I am confident that we will be able to do so.

AAFP policy only speaks to the allowable use of HSA funds for the periodic payment for primary care DPC practice. The bill language meets this objective. We are, however, very concerned with the exclusionary definition of services, specifically pharmaceuticals. Family physicians are not homogenous and the inclusion of a standardized definition and payment rate for “primary care” is concerning. We also are concerned that the allowable periodic payment amount is established irrespective of the patient and their health condition(s).

The other concern we are advancing is the simple fact that the language would apply the permissible use of the HSA to the periodic payment and not the patient themselves. This is nuanced, but basically the permissible amount should apply only to the patient/HSA holder and should have no impact on the practice or the practice’s financial operations.

There are other structural issues, but these are the big items we are working on.

Have a nice weekend – SM

Update 2: From: Shawn Martin, Date: October 25, 2019 at 2:06:39 PM EDT

October 25, 2019 at 2:06:39 PM EDT

I think the challenge in the next few weeks is this – is there a pathway to codify the permissible use of HSA funds for the explicit purpose of periodic membership payments and, if yes, what is the scope of services for such a permissible payment.

The relationship between not permissible (current) and permissible at $x (as proposed in legislation) is not the point in my mind.  The point is providing clarity in statute that an individual may use their HSA funds for a defined purpose – in this case periodic payments to a DPC practice.  Any limitation on the amount of a permissible expenditure is secondary to the permissibility question more generally.  There are defined limits on tax advantage accounts broadly – FSA, CTC, mortgage deduction, SALT, etc.

Its an interesting policy question that I have been kicking around since the ACA.  The HRA is cleaner because it is a defined contribution.  Anyway – look forward to the call with you and others.

---

10/24/2019 letter from IP4PI founder Craig M. Wax, DO to AAFP Senior Vice President for Advocacy, Practice Advancement and Policy, Shawn Martin:

Dear Shawn

Long time no see, or hear for that matter. I hope you and your family are well and that you landed safely at another entity. I’m writing to express concern about HR 3708 in the House and AAFP support of it. AAFP has been supportive of DPC in recent past and that support is much appreciated, but this bill, as written, would do more harm than good.

Enacting an aggregate cap on patient use of HSA funds for access to value-based care would be a bad precedent and the proposed prohibition on the ability of physicians to include medications in a DPC agreement is contrary to the best interests of patients.

In addition, all specialties, not just primary care, should be permitted to arrange innovative direct payment arrangements with the patient, eliminating the middleman and optimizing care with reduced cost.  HR 3708 appears to preclude the ability of a patient with diabetes from using HSA funds to pay for a monthly arrangement with an endocrinologist, for instance.

The bill also seems to risk the potential for States and others to misclassify DPC as an insurance plan by not properly and clearly defining DPC as medical care.

In its current form, this bill is unacceptable and I am disappointed that AAFP is supporting it. The previous Primary Care Enhancement Act from 2017 (HR 365) was an excellent template, while HR 3708 is flawed.

Please let me know what can be done to revoke AAFP support for this harmful legislation, and work for better options to support DPC and empower both physician and patient independence.

Best wishes for good health,
Craig M. Wax, DO
Family Physician
Independent physicians for patient independence
National Physicians Council on Healthcare Policy member
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax 

I signed! American Academy of Family Physicians: Urge the AAFP to cease their support of HR3708 – Sign the Petition! https://t.co/1BMoG5SwVD via @Change

— AtlasMD (@AtlasMD) October 24, 2019

Help Stop Blatant attempt to Blur Lines Between Physician and Non Physician

Amy Townsend, MD of Physicians for Patient Protection writes in:

Certified Registered Nurse Anesthetists (CRNAs) are working to get the Idaho Board of Nursing (BON) to officially change their name from nurse anesthetist to NURSE ANESTHESIOLOGISTS.  

This is a blatant attempt to blur lines between physician and non physician and to deceive the public.  The American Association of Nurse Anesthetists (AANA) plans to do this in every single state.  

It is important that we all stand up to these assaults on our colleagues in every specialty.  

Please help by spreading this information and signing this letter (after modifying it to your satisfaction).

Transparency in healthcare is critical.  And this name change is the exact opposite of what healthcare needs.  

Link to Letter: https://asahq.quorum.us/campaign/22999/

Do Not Gloss Over the Devastating Impacts of Policies that Declare Mid-Levels are Equivalent to Physicians

Friend of IP4PI Amy Townsend, MD writes in:

Please do not gloss over the potentially devastating impacts that Section 5 of President Trump’s Executive Order on Medicare will have on our healthcare system.  

I am a board member for Physicians for Patient Protection, a grassroots physician group that promotes physician led care.  We have been actively fighting scope of practice invasion in nearly every state for the last 3 years.  NPs and PAs can be a valuable part of a physician led team but they are not equivalent to physicians in education, training, or ability.  The government permitting them to independently practice medicine through legislation and not education will devastate healthcare.  Here are a few of my concerns:

1.  Patient safety, patient safety, patient safety!!!!

As NPs try to increase their numbers, they have sacrificed the quality of NP education.  They have created degree mills that are churning out 27,000 NPs per year.  Many schools have 100% acceptance and didactics that are 100% online and can be completed in as little as 18 months.  This is followed by a mere 500 hours of shadowing as their “clinical experience”.  Compare this to 16,000 clinical hours for a family medicine physician.  We are seeing and hearing devastating stories of misdiagnosis and mismanagement of these poorly trained practitioners daily.

2.  Medical expertise will be gradually diluted down.  

Why will our best and brightest students even try to conquer to academic rigors and expense of medical school when you can take a cheaper, less time consuming course to practicing medicine independently and have the same reimbursement (due to pay parity proposed here).  As a Family Medicine physician that has been practicing almost 15 years, I value every second of my training.  It is needed for me to be an expert at my craft.  

3.  NPs and to a lesser extent PAs, in general are corporate YES men.  

They have not been taught in their training to take ownership of patients as physicians do.  They do not take the same oath to protect patients at all costs.  If they are declared physician equals and can replace physicians, we will lose all negotiating power with corporate entities, government, and insurance companies.  If physicians stand up for patients, they will simply be replaced by a more agreeable, complacent NP.  
There are probably a million additional reasons.  But it is late and I’m sure you all are tired of reading my rant.  But I am begging you all to please give this issue it’s due respect.  The president has it WRONG on this issue.  We can not continue to have this conversations in the dark corners because we are afraid of liking like we are being mean to nurses.  Our profession, our fellow physicians, and our patients need us to speak up.  

Thank you all for your wonderful advocacy.  I believe it is people like us that can and will fix our broken system. 

Amy Townsend, MD, Family Medicine/Hospital Medicine

Cost transparency in BILLING!

By Paul Kempen, MD, PhD

Price transparency is a fallacy regarding posting of lists of costs when insurance is involved. Perhaps transparency in BILLING is more reasonable to create individual outrage regarding outrageous bills. Please consider the following:

Cost transparency in BILLING!

I want to hear if anyone sees the following proposal as useful in separating physicians out from the “cost of care”. The issue of transparency is nebulous “going into” getting care for a number of reasons. Patients are often ill, in urgent need, in a “closed market” and poorly educated.  Perhaps it  would be useful to push for legislation creating transparency of ALL BILLS, especially those produced by insurance companies which serve to foster that impression that insurance somehow actually pays for care.  Insurance controls payments through ”negotiated prices”, limitation of care delivery and other aspects. I question if it would it be useful to have laws which Demand EVERY “This is NOT a bill” produced by corporate entities include the following data:

HOSPITAL AND INSURANCE STATEMENTS

1) Itemized price charged (i.e. charge-master and/or “full billed price”)

2) Amount ACTUALLY PAID by insurance independent of  patient portion separated from negotiated deductions

3) What Medicare would have paid for every BILLED service in A) HOSPITAL and B) regional Doctor’s office

4) All facility fees separated from total cost as a separate component

Imagine if everyone SEES the “facility fee” and recognizes that doctor offices are CHEAPER!!

If everyone sees the hyperinflated insurance/hospital costs over physician offices

If everyone sees that the PATIENT is paying for care via the deductible and sees just how LITTLE insurance companies are paying from the large premium and this is NOT hidden in the “negotiated deductions” which gives an appearance of “saving money” for patients.

Anyone producing a bill MUST have access to such data and making everyone aware of these realities would create pressure on OVERCHARGES

Debunking Myths that NPs Increase Rural Access and Lower Costs

The “increased rural access” and “lower cost” rhetoric used to support nurse practitioner autonomy is a complete fallacy and there is zero data to support these claims.  

1.  The market factors that make it difficult for physicians to practice in rural, underserved areas is not any different for NPs than it is for physicians.  NPs are not independently more altruistic than physicians.  Poor payer mix and the expense of excessive regulatory burdens will make it difficult for anyone to keep their doors open in these areas.  

2.  Look at the states that have allowed NP independent practice for decades, like Arizona.  NPs are practicing in the exact same places as physicians.  They do not go to rural areas.  There are maps available from AMA that show this quite clearly.  

3.  There are multiple studies that show NPs make more referrals to specialists, order more inappropriate radiology studies, and perform more skin biopsies than physicians.  This all INCREASES cost to the healthcare system.  In practice, I see NPs ordering tons of worthless tests in order to try to bridge the gaps in their knowledge.  They order tests and then have no idea what to do with them which leads to more tests and more referrals.  At a time when we are focused on decreasing unneeded healthcare waste, how does it make sense to use these undertrained non physicians.  

4.  If they are arguing for pay parity, how exactly do they decrease healthcare costs?

Data references demonstrating NPs increase cost and lower quality:

NPs order more biopsies: https://doc-10-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/f3drubbtuuasggve85q8h4dmet2ru2n5/1570492800000/11904212300552749650/00862855625573411785/1Oa8BCwnGYyN8Qwxg4bk6NYPdEeaQETHw?e=download&nonce=5nnu0081r77o6&user=00862855625573411785&hash=rldhsra0pp9qca2lt28lrf0ccab5h8f2

NPs order more imaging: 
https://doc-04-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/8gvilblg17297cb1rr7h0rg62tem57o5/1570492800000/11904212300552749650/00862855625573411785/1khlK1Uaw9ZKBES85GxnAICJW9_QUS4qi?e=download

NPs make more referrals to specialists: https://doc-0c-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/pd0vv46pqfms4l8gfhefl9rtbjsjbnl9/1570492800000/11904212300552749650/00862855625573411785/1BYA0yZwLoHB0ozC8vOL6NVrHnDYj18MI?e=download

Prescribe more antibiotics =more antibiotic resistance: 
https://doc-00-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/v0hj5lspvacc5qch9p312rn4hruf6b9u/1570492800000/11904212300552749650/00862855625573411785/1ifSQYhGKCQAzwqNWefUS5x7PA2G8HC5C?e=download

More general resources  https://drive.google.com/drive/mobile/folders/1FF7sTKg4XZa_L5mXpW2puGjlMU3BuwcO/1IwfXD0e5Lxk9BuJoPtD2egwQySsozxdS/1z-L86XfVOzW6KPFpolF13ltCEWrI3Vv5/1S3iJlDPUcGBiLZmVgK7CYolis8eiv41i?sort=13&direction=a

 

Nurse Crusader Admits Her Dreams for “Doctor Nurses” Have Been Shattered.

Dr. Alieta Eck writes in:

I encourage everyone to read about a fascinating article from the infamous Mary Mundinger, former Dean of Columbia University’s School of Nursing, the nurse crusader who championed to put nurses on a more equal footing with doctors. The piece is titled: “Potential Crisis in Nurse Practitioner Preparation in the United States.”

Basically, this article reads like a tell-all novel about how her dreams for “doctor nurses” have been shattered.

Essentially they reviewed all the DNP programs since inception in 2005.

85% of DNP programs are nonclinical (ie admin and policy) and do not require ANY new clinical skills.

Only 18% of the programs are clinical and DO require clinical skills beyond masters level MSN or BSN.

She says the public good requires clinical programs but says they haven’t developed because it’s too difficult and expensive for schools to develop clinical tracks.

Her final conclusion is that nursing education is failing to prepare most DNPs for clinical practice. Finally an admission that the DNP degree, by having 2 entirely different educational tracks, is meaningless.

75 Years After D-Day It’s Time to End a Failed WWII-Era Economics Experiment … and solve the surprise billing quagmire too

It’s a sign of the divisive times: even the American business community is throwing its own under the Congressional bus. In a letter to the Senate HELP committee, a broad coalition of employers, including the National Restaurant Association, Auto Care Association, and the National Association of Wholesaler-Distributors, is calling on Congress to impose price controls on others that they would not tolerate being placed on themselves.

Yes, even the “Small Business & Entrepreneurship Council,” is joining this coalition, whose arcane name is a throwback to 1970s era overregulation—ERIC, the ERISA Industry Committee—to ask for legislation that is anything but entrepreneurial.  

These businesses are part of the growing chorus asking Congress to “do something” to address “surprise” medical bills. But instead of focusing on the root causes of the problem, ERIC, and others are demanding heavy handed price controls that will harm the physicians who render life saving medical care — often small businesses themselves. 

And putting the squeeze on physicians with government set fees, that may not even cover costs bloated by complying with a sea of federal regulation, ultimately harms patients’ ability to obtain high-quality, timely care in situations where care is most needed.

Let’s take a closer look at the real cause of the problem, and solutions that will put patients in the driver’s seat instead of putting their access to care on the hot seat.

“Surprise, your insurance plan is not going to cover the care you received,” is another way to describe the situation. Of course, insurers want to limit their costs, as any business would, and those who provide care want to be paid well for their services. 

But how much should emergency medical care cost? In a functioning marketplace prices are determined through an immeasurable number of mutually beneficial transactions between customers and producers, not by federal fiat. 

But American medicine is anything put a healthy market. 

The fact that ERIC is demanding price controls points to a big reason this is the case. Employers are stuck between employees and their medical care thanks to the downstream consequences of wage controls in WWII that spawned tax-deductible employer-funded health benefits. D-Day was 75 years ago, and while Europe was freed, flawed government economic decisions from the War are still trapping Americans “in-network” with soaring medical prices, deductibles, and co-payments, not to mention premiums.

Because employers and other third parties are often in charge of paying the bill and negotiating costs, patients have lost their leverage and pricing becomes untethered from the marketplace mechanisms that, for instance, have put not just a chicken in every pot, but supercomputers in the pockets of virtually every American over age 13, and a car (or two) in nearly every garage.

It’s time to begin extracting the employer from the health care equation. ERIC and its members can be freed from the burden of overseeing and paying for their employees’ care. Employers don’t like shouldering this responsibility and employees shouldn’t want their employer interfering in the exam room or operating suite.  And, sorry Berniacs, Medicare for All is not the right way to go about winding down employer-based coverage.

One answer is to give patients better options to become independent of their employer for their care, like through expanding Health Savings Accounts with the flexibility to be used to buy catastrophic coverage or pay Direct Primary Care (DPC) arrangements.

Another more long term goal, but one in line with the American spirit of freedom and individualism is to end the $280 billion tax exclusion for employer-based insurance benefits altogether. Increase wages and salaries proportionately and cut taxes across the board. Employees can then decide for themselves how to spend their hard earned dollars, whether on insurance, directly on care, or however they choose.  

This would be a win-win-win, for employers, employees, and all patients. A re-energized marketplace will unleash more competition and more facilities and practices emulating the likes of the Surgery Center of Oklahoma (knee-replacements can be 50% less than through “coverage”) , Atlas MD (unlimited primary care for $50/month, $2 lab tests, and wholesale cost prescriptions), and Green Imaging (home of the $250 MRI) where direct-to-patient pricing, that eschews insurance contracts, is a fraction of what “in-network” options charge for the same care. And yes, competition even works to lower the cost of emergency care, as demonstrated by lower-cost transparent physician-run ER and urgent care options already popping up in Arizona, Oklahoma, Texas, and elsewhere across the U.S.

So instead of a surprise bill, patients will be pleasantly surprised at how affordable and accessible high-quality medical care is even for emergencies, when they, not their employer, insurance CEO, Member of Congress, or government bureaucrat are the customer.

---

Action Item: Visit https://action.stoppricefixing.org/ and learn how to make an immediate difference in the fight to stop flawed legislation.

16 Bills to Expand Flexibility of Health Savings Accounts #HSA #HSAs

Thank you to Kim Corba, DO for compiling this list of bills under consideration in Congress intended to increase the flexibility of Health Savings Accounts.

H.R.3565 — 116th Congress (2019-2020) Veterans Health Savings Account Act Sponsor: Rep. Gosar, Paul A. [R-AZ-4] (Introduced 06/27/2019) Cosponsors: (7) Committees: House – Ways and Means Latest Action: House – 06/27/2019 Referred to the House Committee on Ways and Means.

This billallows veterans who receive hospital care or medical servicesunder any law administered by the Department of Veterans Affairs to remaineligible to participate in or contribute to a health savings account.

H.R.2177 — 116th Congress (2019-2020) Faith in Health Savings Accounts Act of 2019 Sponsor: Rep. Kelly, Mike [R-PA-16] (Introduced 04/09/2019) Cosponsors: (23) Committees: House – Ways and Means Latest Action: House – 04/09/2019 Referred to the House Committee on Ways and Means.

This billmodifies the requirements for health savings accounts (HSAs) to treat membership in atax-exempt health care sharing ministry as coverage under a high deductible health plan forpurposes of the tax deduction for contributions to an HSA.

H.R.603 — 116th Congress (2019-2020) Health Savings AccountExpansion Act of 2019 Sponsor: Rep. Gallagher, Mike [R-WI-8] (Introduced 01/16/2019) Cosponsors: (14) Committees: House – Ways and Means Latest Action: House – 03/01/2019Referred to the Subcommittee on Health.

This bill modifies the requirementsfor health savings accounts (HSAs) to:

• increasethe maximum contribution amounts,
• permitthe use of HSAs to pay health insurance premiums and for directprimary care service arrangements,
• repealthe restriction on using HSAs for over-the-counter medications,
• eliminatethe requirement that a participant in an HSA be enrolled in a highdeductible health care plan, and
• decreasethe additional tax for HSA distributions not used for qualified medicalexpenses.

H.R.457 — 116th Congress (2019-2020) Health Savings Account Act Sponsor: Rep. Fortenberry, Jeff [R-NE-1] (Introduced 01/10/2019) Cosponsors: (0) Committees: House – Ways and Means Latest Action: House – 01/10/2019 Referred to the Subcommitteeon Health.

This bill modifies the requirementsfor health savings accounts (HSAs) to (1) increasethe maximum contribution limits for HSAs to match the sum of the annualdeductible and out-of-pocket expenses permitted under a highdeductible health plan, (2) allow individualswho receive primary care services in exchange for a fixed periodic fee orpayment to participate in an HSA, and (3) permit HSAs to beused for fitness center memberships.

The bill also allows a medical caretax deduction for periodic provider fees, including (1) periodicfees paid to a primary care physician for a defined set of medical services or theright to receive medical services on an as-needed basis; and (2) pre-paidprimary care services designed to screen for, diagnose, cure, mitigate, treat,or prevent disease and promote wellness.

S.2440 — 116th Congress (2019-2020) Qualified Health Savings AccountDistribution Act of 2019 Sponsor: Sen. Sasse, Ben [R-NE] (Introduced 08/01/2019) Cosponsors: (0) Committees: Senate – Finance Latest Action: Senate – 08/01/2019 Read twice and referred to the Committeeon Finance.

Official text still being written.  Quick summary—this bill proposes funds can be moved from FSAs and HRAs into HSAs

S.2441 — 116th Congress (2019-2020) Health Savings Account Expansion Actof 2019 Sponsor: Sen. Sasse, Ben [R-NE] (Introduced 08/01/2019) Cosponsors: (0) Committees: Senate – Finance Latest Action: Senate – 08/01/2019 Read twice and referred to the Committeeon Finance.

Allow individuals who are not enrolled in a highdeductible health planto have access to health savings accounts, 

H.R.4576 — 116th Congress (2019-2020)To amend the InternalRevenue Code of 1986 to allow contributionsto health savings accounts in the case of individuals withspouses who have health flexible spending accounts. Sponsor: Rep. Wexton, Jennifer [D-VA-10] (Introduced09/27/2019) Cosponsors: (2) Committees: House – Ways andMeans LatestAction: House – 09/27/2019 Referred to the House Committee on Waysand Means.

As of09/30/2019 text has not been received for H.R.4576 – To amend theInternal Revenue Code of 1986 to allow contributions to health savings accounts in the case of individuals with spouses whohave health flexiblespending accounts.

H.R.4530 — 116th Congress (2019-2020) To amend the InternalRevenue Code of 1986 to permit individuals eligible forIndian Health Service assistance to qualifyfor health savings accounts. Sponsor: Rep. Moolenaar, John R. [R-MI-4] (Introduced09/26/2019) Cosponsors: (1) Committees: House – Ways andMeans LatestAction: House – 09/26/2019 Referred to the House Committee on Waysand Means.

As of09/30/2019 text has not been received for H.R.4530 – To amend the InternalRevenue Code of 1986 to permit individuals eligible for Indian Health Service assistance to qualify for health savings accounts.

S.12 — 116th Congress (2019-2020) Health Savings Actof 2019 Sponsor: Sen. Rubio, Marco [R-FL] (Introduced 01/03/2019) Cosponsors: (1)Committees: Senate – Finance Latest Action: Senate – 01/03/2019 Readtwice and referred to the Committee on Finance.

This bill modifies the requirementsfor health savings accounts (HSAs) to

• rename highdeductible health plans as HSA-qualified health plans;
• allow spouses who haveboth attained age 55 to make catch-up contributions to the same HSA;
• make Medicare Part A(hospital insurance benefits) beneficiaries eligible to participate in an HSA;
• allow individuals eligiblefor hospital care or medical services under a program of theIndian Health Service or a tribal organization to participate in anHSA;
• allow members ofa health care sharing ministry to participate in an HSA;
• allowindividuals who receive primary care services in exchange for a fixed periodicfee or payment, or who receive health care benefits from an onsitemedical clinic of an employer, to participate in an HSA;
• include amounts paid forprescription and over-the-counter medicines or drugs as “qualified medicalexpenses” for which distributions from an HSA or othertax-preferred savings accounts may be used;
• increase the limits on HSAcontributions to match the sum of the annual deductible and out-of-pocketexpenses permitted under a high deductible health plan; and
• allow HSA distributions tobe used to purchase health insurance coverage.

The bill also: (1) exempts HSAs from creditor claims in bankruptcy,and (2) reauthorizes Medicaid health opportunity accounts.

The bill allows a medical care tax deduction for: (1) exerciseequipment, physical fitness programs, and membership at a fitness facility; (2)nutritional and dietary supplements; and (3) periodic fees paid to a primarycare physician and amounts paid for pre-paid primary care services.

 H.R.3796 — 116th Congress (2019-2020) Health Savings for Seniors Act Sponsor: Rep. Bera, Ami [D-CA-7] (Introduced 07/17/2019) Cosponsors: (1)Committees: House – Ways and Means Latest Action: House – 07/17/2019 Referred to the House Committee on Waysand Means.

This bill permits a Medicare beneficiary to participate in andcontribute to health savings accounts.

H.R.2878 — 116th Congress (2019-2020) Homecare for Seniors Act Sponsor: Rep. Porter, Katie [D-CA-45] (Introduced 05/21/2019) Cosponsors: (10) Committees: House – Ways and Means Latest Action: House – 05/21/2019Referred to the House Committee on Ways and Means

This bill allow tax-exempt distributions from health savings accounts (HSAs)to be used for qualified home care.

“Qualified home care” includes a contract to provide threeor more of the following services in the residence of the service recipient

• assistance with eating,
• assistance with toileting,
• assistance withtransferring,
• assistance with bathing,
• assistance with dressing,
• assistance withcontinence, and
• medication adherence.

The Department of Health and Human Services must carry outa campaign to increase public awareness of the in-home service expenses thatare eligible for tax-free distribution from HSAs.

 S.1089 — 116th Congress (2019-2020) Restoring Access to Medication Act of 2019 Sponsor: Sen. Roberts, Pat [R-KS] (Introduced 04/09/2019) Cosponsors: (3)Committees: Senate – Finance Latest Action: Senate – 04/09/2019 Read twice and referred to the Committeeon Finance.

This billrepeals provisions of the Internal Revenue Code, as added by the PatientProtection and Affordable Care Act, that limit payments for medicationsfrom health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs orinsulin (thus allowing distributions from such accounts for over-the-counterdrugs).

H.R.908 — 116th Congress (2019-2020) Stop Penalizing Working Seniors Act Sponsor: Rep. Latta, Robert E. [R-OH-5] (Introduced 01/30/2019) Cosponsors: (5)Committees: House – Ways and Means Latest Action: House – 01/30/2019 Referred to the House Committee on Waysand Means.

This bill allows Medicare-eligible individuals who are age 65 or olderto contribute to health savings accounts iftheir entitlement to Medicare benefits is limited to hospital insurancebenefits under Medicare Part A.

H.R.3708 — 116th Congress (2019-2020)Primary Care Enhancement Act of 2019Sponsor: Rep. Blumenauer, Earl [D-OR-3] (Introduced 07/11/2019) Cosponsors: (5)Committees: House – Ways and MeansLatest Action: House – 07/11/2019 Referred to the House Committee on Ways and Means.

This bill permits a taxpayer with a primary care service arrangement whose fixed periodic fee does not exceed $150 a month to participate in and contribute to a health savings account. Read about flaws in H.R. 3708 at https://dpcaction.com/take-action-dpc-action-statement-opposing-hr-3708/

H.R.2163 — 116th Congress (2019-2020) Freedom for Families Act Sponsor: Rep. Biggs, Andy [R-AZ-5] (Introduced 04/09/2019) Cosponsors: (20) Committees: House – Ways and Means Latest Action: House – 04/09/2019 Referred to the House Committee on Waysand Means

To amend the Internal Revenue Code of 1986 to allow fortax-advantaged distributionsfrom health savings accounts during family or medicalleave, and for other purposes.

 H.R.3594 — 116th Congress (2019-2020) Healthcare Freedom Act of 2019 Sponsor: Rep. Roy, Chip [R-TX-21] (Introduced 06/28/2019) Cosponsors: (10) Committees: House – Ways and Means Latest Action: House – 06/28/2019 Referred to the House Committee on Waysand Means. 

This bill expands the availabilityof health savings accounts. It renamessuch accounts as “health freedom accounts” andallows all individuals to receive increased tax deductions for contributions tosuch accounts. The term “qualified medical expenses” is expanded toinclude costs associated with direct primary care, health caresharing ministries, and medical cost sharing organizations.

The bill also excludes employercontributions to health freedom accounts from employeegross income for income tax purposes.