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HSA, FSA Bills Get Their CBO Reviews

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House Republican leaders hope to pry Democratic senators away from the team defending the Patient Protection and Affordable Care Act (PPACA) by sending over three personal health account bills that have won the votes of a significant number of Democrats in the House.

The Congressional Budget Office (CBO) has posted budget impact reviews of the health account bills on its website. 

The House Rules Committee has posted a section-by-section summary of a package that includes the health account bills and a better-known bill, H.R. 436.  H.R. 436 would repeal a PPACA provision that would impose a 2.3% excise tax on medical devices other than eyeglasses, contact lenses, hearing aids and some other devices sold in retail stores.

Here’s a version of the H.R. 436 and health account bill package formatted as a bill.

The health account bills in the summary are H.R. 1004, a bill that could eliminate the flexible spending account (FSA) “use it or lose it” rule; H.R. 5858, a bill that could change health savings account (HSA) tax rules; and H.R. 5842, a bill that could repeal a PPACA provision that prohibits holders of FSAs and HSAs from using the account assets to pay for over-the-counter (OTC) drugs unless the drugs are prescribed by a doctor.

The House Ways and Means Committee marked up the bills last week.

The committee passed H.R. 1004 by a vote of 23-6, including “yea” votes from 5 of the 15 Democrats on the Committee.

H.R. 5842 won by a vote of 24-9, with support from 3 Democrats; and H.R. 5858 won by a vote of 21-7, with support from 2 Democrats. All Republicans who participated voted for all 3 bills. 

House Speaker John Boehner, R-Ohio, and House Majority Leader Eric Cantor, D-Va., have been using blogs and Twitter feeds to promote H.R. 436, the medical device tax bill. Cantor says a vote on H.R. 436 could come Friday between 9 a.m. and 3 p.m.

CBO analysts estimate that H.R. 1004 would reduce government revenue by $4.1 billion from 2012 to 2022, H.R. 5842 would reduce revenue by $4 billion, and H.R. 5858 would reduce revenue by $4.7 billion.

The analysts say H.R. 436 would reduce revenue by $29 billion.

If the bills get through the House, they could face trouble advancing in the Senate, where Democrats hold a strong majority.

But the ideas in the bills may have some pull in the Senate as well as in the House.

The Senate version of H.R. 1004 — the bill that would end the requirement that an FSA holder forfeit any unused FSA balance at the end of the year — is S. 1404, a bill introduced by Sen. Ben Cardin, D-Md.

The cosponsor list for S. 1368, the Senate version of H.R. 5842, the OTC drug bill, includes at least 4 Democrats — Benjamin Nelson of Nebraska; Jim Webb of Virginia; Claire McCaskill of Missouri; and Daniel Inouye of Hawaii.


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