The House and Senate are still working through the budget reconciliation measure, also known as President Donald J. Trump’s Big Beautiful Bill. There are thousands of moving parts in the tax portion of the bill, but Republicans are in lockstep that they want to continue the tax reform from the Trump 2017 tax measure. One problem is that horse trading has eliminated some good provisions to pay for other provisions that are not necessary to the bill.
One provision that has been tossed aside by the Senate is one that would help Americans to have more access to health care while promoting the idea of empowering consumers to shop for the best price and care when making those decisions. Senator Mike Crapo (R-ID), Chairman of the Senate Finance Committee, has an opportunity to help Americans who want more options to save to pay for health care expenses. The House of Representatives put in several tax provisions into the tax reform budget reconciliation measure allowing more Americans to use Health Savings Accounts (HSAs) to save for unanticipated expenses. The Senate Finance Committee removed those key provisions but the Senate as a whole can put them back in next week when they have a full debate on the Senate’s version of the tax bill.
One provision that was stripped out by the Finance Committee was an expansion of HSA eligibility to individuals enrolled in Bronze or catastrophic ACA plans. The number of Health Savings Account eligible plans offered in exchanges are few and far between – about 2% of these plans -- and this legislation is essential to open up beneficiaries to the benefits of HSAs. The Senate can fix the problem to help employees and employers who want to provide more health care options. HSAs are low-cost options for employers, many of which are a preferred option of smaller business models, that are much needed to help Americans deal with skyrocketing health care costs.
The companies most in need of help today are struggling small businesses. Insurance premiums are one of the biggest expenses for small businesses and startup companies today. Many of these small businesses can’t afford traditional employer-sponsored plans but want to provide compensation by paying health care costs. If the Congress allows HSA eligibility for high-deductible Bronze or catastrophic plans, the health care options get much better for those the most in need.
The House passed a number of HSA tax reform ideas to allow employers to allocate cash to the employee’s plan. This is a better option than underwriting premiums for a full group, because of cost. The HSA House passed provisions would allow employees to gain access to tax-advantaged funds while allowing small businesses to avoid a financial burden of complete and expensive insurance plans. This reform would help small businesses to survive in a challenging environment.
A June 2025 poll by Harvard CAPS/Harris Poll found the HSA provisions in the One Big Beautiful Bill were the most popular tax cut, polling at 68% support among Democrats, 77% support among Republicans, and 67% among Independents.
This level of support from Americans for HSA is consistent with other polls. A poll by Frank Luntz found 83% support for seniors to have the option of a Health Savings Account if they want one. Another poll found that 87% of Americans support allowing any American who wants an HSA to have one.
One of the great aspects of Health Savings Accounts is to move health care decisions to employees. This will encourage shopping for the best service and an appropriate cost for individuals who have very different needs and health care challenges. The freedom for individuals to manage care is something the Trump Administration supports and this model that puts consumers in charge promotes the idea of value-based care.
Health care experts in the field believe that the House passed provision would provide patient control, flexibility, savings growth and improved access for consumers.
If one is worried about cost, this provision would empower consumers to push health care costs lower, because consumers would be able to make decisions based on cost and their specific needs. This also would give consumers access to a plan that would save for future health care costs.
Our nation’s economy is driven by the millions of small businesses that support the bulk of the employees working today. HSAs are not a concern for large companies that can afford the high-cost plans that cover everything, but small businesses just don’t have the resources to eat that cost. Restoring the House passed HSA provisions would go a long way to making the bill fair to taxpayers while allowing small businesses to survive with increasing health care costs and the challenge of making ends meet.
Brian Darling is former Counsel for Sen. Rand Paul (R-KY).