Universal Health Savings Account Accessibility Act of 2025

A BILL

To amend the Internal Revenue Code of 1986 to expand eligibility for health savings accounts to all United States citizens from birth, enhance their use as triple tax-advantaged vehicles for medical expenses, retirement, and long-term care, and require account providers to act as fiduciaries, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the “Universal Health Savings Account Accessibility Act of 2025”.

SECTION 2. FINDINGS AND PURPOSE.

(a) Findings.—Congress finds the following:

(1) Health care costs in the United States have risen dramatically, placing significant financial burdens on individuals and families.

(2) Health insurance premiums are increasingly unaffordable, and coverage often excludes essential services, leading to high out-of-pocket expenses.

(3) Health savings accounts (HSAs), as established under section 223 of the Internal Revenue Code of 1986, provide a triple tax-advantaged mechanism—pre-tax contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses—but are currently limited to individuals enrolled in high-deductible health plans, excluding millions of Americans.

(4) Expanding HSA eligibility to all citizens from birth would promote personal responsibility for health care savings, reduce reliance on inadequate insurance, and allow for long-term accumulation of funds usable for medical needs, retirement, and long-term care.

(5) Requiring HSA providers to act as fiduciaries ensures that account holders’ interests are prioritized, fostering trust and efficient management.

(b) Purpose.—The purpose of this Act is to make HSAs universally accessible, thereby addressing escalating health care costs, improving financial security for medical and retirement needs, and ensuring equitable tax advantages for all Americans.

SECTION 3. EXPANSION OF HEALTH SAVINGS ACCOUNT ELIGIBILITY AND USES.

(a) Amendments to Section 223 of the Internal Revenue Code.—Section 223 of the Internal Revenue Code of 1986 is amended as follows:

(1) Universal Eligibility.—Subsection (c)(1) (relating to eligible individual) is amended by striking subparagraph (A) and inserting the following new subparagraph:

“(A) who is a citizen of the United States (including individuals from birth, with accounts managed by a parent or legal guardian until the age of majority).”

(2) Removal of High-Deductible Health Plan Requirement.—Subsection (c)(2) (relating to high deductible health plan) is repealed.

(3) Expanded Qualified Medical Expenses.—Subsection (d)(2) (relating to qualified medical expenses) is amended by adding at the end the following new subparagraph:

“(E) Expenses for long-term care services (as defined in section 7702B(c)), including premiums for qualified long-term care insurance contracts.”

(4) Retirement Use Clarification.—Subsection (f)(8) (relating to treatment after age 65) is amended to read as follows:

“(8) TREATMENT AFTER AGE 65 OR FOR RETIREMENT PURPOSES.—Amounts in a health savings account may be withdrawn without penalty for any purpose after the account holder attains age 65, or for retirement expenses (including but not limited to living expenses in retirement), provided that non-qualified withdrawals are included in gross income.”

(5) Fiduciary Requirements for Providers.—A new subsection (i) is added at the end:

“(i) FIDUCIARY DUTIES OF ACCOUNT PROVIDERS.—

(1) IN GENERAL.—Any financial institution or brokerage serving as a trustee or custodian of a health savings account under this section shall act as a fiduciary with respect to the account holder, prioritizing the holder’s best interests in investment options, fees, and account management.

(2) REGULATIONS.—The Secretary, in consultation with the Secretary of Labor, shall prescribe regulations to enforce fiduciary standards, including prohibitions on conflicts of interest and requirements for transparent fee structures.”

(b) Conforming Amendments.—

(1) Section 223(b) (relating to limitations) is amended by adding at the end the following new paragraph:

“(9) CONTRIBUTIONS FROM BIRTH.—For individuals under the age of 18, contributions may be made by a parent, legal guardian, or through government programs, subject to the annual limits under paragraph (2).”

(2) Any other provisions of the Internal Revenue Code of 1986 referencing high-deductible health plans in relation to health savings accounts are amended to remove such references.

SECTION 4. IMPLEMENTATION AND EDUCATION.

(a) Government Contributions for Newborns.—The Secretary of Health and Human Services, in coordination with the Secretary of the Treasury, shall establish a program to provide an initial seed contribution of $500 to a health savings account for each United States citizen at birth, funded through appropriations.

(b) Public Education Campaign.—The Secretary of Health and Human Services shall conduct a nationwide education campaign to inform citizens about the expanded HSA program, including eligibility, contribution methods, investment options, and tax advantages.

(c) Regulations.—Not later than 180 days after the date of enactment of this Act, the Secretary of the Treasury shall issue regulations or guidance necessary to implement the amendments made by this Act.

SECTION 5. EFFECTIVE DATE.

The amendments made by this Act shall apply to taxable years beginning after December 31, 2025.