Lawmakers Push for Expanded Chronic Disease Coverage



Three members of the U.S. House of Representatives are urging the Internal Revenue Service (IRS) to make high-deductible health plans (HDHPs) more accessible for people managing chronic illnesses. Their goal is to broaden the list of chronic disease treatments and services that HDHPs paired with Health Savings Accounts (HSAs) can cover before patients meet their deductibles.

Background: IRS Notice 2019-45 and Chronic Disease Coverage

In July 2019, the IRS issued Notice 2019-45, which allowed HDHPs to provide pre-deductible coverage for 14 specific treatments and services related to chronic conditions. These include:

• Beta-blockers for heart failure or coronary artery disease
• Blood pressure monitors for hypertension
• Insulin and other glucose-lowering agents for diabetes
• Glucometers and hemoglobin A1c testing for diabetes
• Inhaled corticosteroids for asthma
• Statins for heart disease or diabetes
• Retinopathy screening for diabetes
• Peak flow meters for asthma
• Angiotensin-converting enzyme (ACE) inhibitors for heart failure, diabetes, or coronary artery disease
• Anti-resorptive therapy for osteoporosis or osteopenia
• International Normalized Ratio (INR) testing for liver disease or bleeding disorders
• Low-density Lipoprotein (LDL) testing for heart disease
• Selective Serotonin Reuptake Inhibitors (SSRIs) for depression

Recent Legislative Efforts: The Chronic Disease Flexible Coverage Act

House Ways and Means Chairman Jason Smith (R-MO), Health Subcommittee Chairman Vern Buchanan (R-FL), and Representative Jim Panetta (D-CA) have called on the IRS to update and expand the list of covered chronic disease management services. Their bipartisan bill, the Chronic Disease Flexible Coverage Act (H.R. 919), would codify the 2019 IRS guidance into federal law and allow for future updates to the list of covered services. The House passed this bill by voice vote in March 2025, and it is now under consideration in the Senate.

Most Recent Update: IRS Notice 2024-75

In October 2024, the IRS issued Notice 2024-75, further expanding the list of preventive care benefits that can be covered pre-deductible by HSA-eligible HDHPs. The new additions include:

• Over-the-counter oral contraceptives
• Male condoms
• Continuous glucose monitors and insulin
• Breast cancer screening services

This expansion means that HDHPs can now offer pre-deductible coverage for a total of 18 specific medications and services for chronic disease management and preventive care.

Potential Impact

Expanding the list of pre-deductible chronic disease and preventive treatments could make HDHPs more appealing to individuals with ongoing health needs, potentially increasing enrollment in these plans. Supporters argue that broader coverage will help patients manage their conditions more effectively and reduce financial barriers to essential care.

Key Takeaways

• The IRS currently allows HDHPs to cover 18 specific chronic disease and preventive care treatments before the deductible is met. 1
• Lawmakers are advocating for an expanded list to better serve Americans with chronic illnesses.
• Legislative efforts are underway to make these changes permanent and adaptable to future health care advancements.

This ongoing policy discussion highlights the need to balance affordability, access, and comprehensive coverage for individuals with chronic health conditions.