Chronic Disease Flexible Coverage Act
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Would give permanent statutory authority to an IRS administrative guidance (Notice 2019-45) that lets high-deductible health plans cover specific treatments for chronic conditions — such as insulin, statins, and blood pressure monitors — below the plan's normal deductible, keeping those plans eligible for pairing with health savings accounts.
Without this codification, the IRS guidance could be modified or withdrawn at any time, leaving millions of people with HDHPs and chronic conditions vulnerable to losing low-cost access to essential medications and monitoring tools.
What this bill would do
What it would do
The bill would give the force of law to IRS Notice 2019-45, which expanded the list of preventive care services that high-deductible health plans (HDHPs) may cover before a deductible is met — or with a below-minimum deductible — without losing their status as HSA-eligible plans. The specific treatments covered include ACE inhibitors for heart failure or diabetes, statins and beta-blockers for heart disease, inhaled corticosteroids and peak flow meters for asthma, insulin and glucometers for diabetes, blood pressure monitors for hypertension, anti-resorptive therapy for osteoporosis, and SSRIs for depression, among others.
The bill does not itself add new treatments beyond those already listed in the 2019 IRS notice. A separate "no-inference" clause makes clear that codifying this notice does not constrain or expand the IRS's authority to issue other guidance on preventive services under the same code section.
Key provisions
- 1Would give the force of law to IRS Notice 2019-45, allowing HDHPs to cover listed chronic-disease treatments as preventive care below the minimum deductible.
- 2Would include a no-inference clause clarifying the codification does not affect other IRS rules or guidance on preventive services under the same code section.
Who would be affected
People enrolled in high-deductible health plans who also use health savings accounts and have chronic conditions such as diabetes, heart disease, hypertension, asthma, osteoporosis, or depression. Health insurers offering HDHP products would also be affected, as would employers who sponsor HDHPs for their workers.
Why it matters
Currently, the expanded preventive care list exists only as IRS administrative guidance, which can be changed or withdrawn without Congress. Codifying it means patients relying on HDHP coverage for insulin, statins, or similar chronic-disease treatments would have a firm legal basis to expect those items covered pre-deductible, providing greater financial predictability for people managing ongoing health conditions.
What would change
Changes to existing law
Amends Internal Revenue Code of 1986, § 223(c)(2)(C) (Sec. 2(a))
Gives statutory authority to IRS Notice 2019-45's expanded list of chronic-disease preventive care items that HDHPs may cover below the minimum deductible.
Agencies directed to act
How implementation would work
The bill is largely self-executing: it gives statutory force to existing IRS Notice 2019-45 by declaring that the guidance listed therein "shall have the same force and effect as if included in the enactment of this Act." No new agency rulemaking is required. The IRS retains authority to issue further guidance on other preventive services under the same code section, but cannot unilaterally withdraw the codified treatments without a subsequent act of Congress.
Legislative status & sources
Latest action
Received in the Senate and Read twice and referred to the Committee on Finance.
Official CRS summary
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This bill provides statutory authority for guidance from the Internal Revenue Service (IRS) that expands the types of preventive care that may be offered under a high deductible health plan (HDHP) without requiring a deductible or with a deductible below the minimum threshold.
Under current law, to be considered health savings account-eligible, an HDHP must have a deductible above a certain minimum threshold amount, which is adjusted annually. However, an HDHP may cover certain types of preventive care without requiring a deductible or with a deductible below the minimum threshold.
The IRS issued guidance expanding the types of preventive care that may be covered by an HDHP without requiring a deductible or with a deductible below the minimum threshold to include
- angiotensin converting enzyme inhibitors for individuals with congestive heart failure, diabetes, or coronary artery disease;
- anti-resorptive therapy for individuals with osteoporosis or osteopenia;
- beta-blockers for individuals with congestive heart failure or coronary artery disease;
- blood pressure monitors for individuals with hypertension;
- inhaled corticosteroids and peak flow meters for individuals with asthma;
- insulin and other glucose lowering agents, retinopathy screening, glucometers, and hemoglobin A1c testing for individuals with diabetes;
- international normalized ratio testing for individuals with liver disease or bleeding disorders;
- low-density lipoprotein testing for individuals with heart disease;
- statins for individuals with heart disease or diabetes; and
- selective serotonin reuptake inhibitors for individuals with depression.
The bill provides statutory authority for the IRS's guidance.
Legislative subjects
Health care costs and insurance; Health care coverage and access; Health promotion and preventive care; Income tax deductions; Taxation