The 'HSA for All' Bill: Turbocharges Health Savings, Allows Gym Fees, and Creates New Group Insurance Pools

This legislation, the Health Marketplace and Savings Accounts for All Act, is a major shake-up designed to put more money and control into individual hands when it comes to healthcare spending. The bill focuses on two massive changes: making Health Savings Accounts (HSAs) significantly more powerful and creating new ways for freelancers and small business employees to get group health insurance.

The HSA Upgrade: No High-Deductible Required

Right now, you can only contribute to an HSA if you pair it with a High-Deductible Health Plan (HDHP). This bill wipes that requirement clean (Title I). If this passes, anyone can open and fund an HSA, regardless of what kind of insurance they have—or even if they have no insurance at all. This is a game-changer because it takes a tax-advantaged savings vehicle previously limited to HDHP users and opens it up to the entire market.

On top of that, the bill dramatically increases the annual contribution limit to match the limit for 401(k) retirement plans. For busy people juggling rising costs, this means you can stash away far more pre-tax money for future medical bills, and those funds are protected from creditors under new bankruptcy provisions similar to those for your IRA.

Spending Your Savings on Wellness

Perhaps the most relatable change is how you can spend those HSA dollars. Currently, the list of eligible expenses is pretty strict. Under this bill, that list expands to include payments for direct primary care arrangements, vitamins, dietary supplements, and—get this—gym memberships and wearable fitness trackers (Title I). The idea is to shift the focus toward preventative health. For the average person, this means you could potentially pay for your monthly gym dues or that new fitness watch with tax-free money. While this offers great flexibility, it also means the IRS will have to define where the line is drawn for 'supplements' and 'wellness,' which could get complicated fast.

Group Coverage for the Gig Economy

The second major thrust of the bill is creating new avenues for group health insurance, particularly for those who are self-employed or work for small businesses that don't offer coverage. The bill establishes "health marketplace pools" (Title II). These pools are essentially organizations—like professional associations or trade groups—that can act like a single large employer for the sole purpose of offering group health plans to their members.

If you're a freelance graphic designer or a plumber who runs a two-person shop, this could be huge. Instead of navigating the individual marketplace, you could join a pool through your professional organization and access potentially lower-cost group rates. The bill is careful to state that joining a pool doesn't create an employer-employee relationship in any other legal sense, which protects the pool sponsors and the members.

The Trade-Off: Who Pays the Price?

While the expansion of HSAs and group access is a clear benefit for consumers, there's a serious structural concern here. HSAs were originally designed to encourage people to choose HDHPs, which lower monthly premiums but increase out-of-pocket costs, theoretically making consumers more cost-conscious. By removing the HDHP requirement, the bill risks creating what policy analysts call adverse selection.

Think of it this way: If healthier people can now ditch their standard, full-coverage plans (which tend to be more expensive) and just use a beefed-up HSA for the occasional expense, they might leave the traditional insurance pools. When the healthy people leave, the remaining pool consists disproportionately of sicker, more expensive members. This drives up the premiums for everyone left in the standard plans—the people who rely on comprehensive coverage the most. This is a significant risk that could destabilize the traditional insurance market, even as it provides massive savings flexibility to those who can afford to max out their new, much larger HSA contribution limits.