What it means: HSAs let workers with high-deductible health plans contribute pretax earnings to the HSAs and use the cash to pay for medical care without paying federal income taxes on the distributions. The odds that HSAs and cash-for-coverage HRAs will be much more flexible in 2026 have increased.

The package's new HSA and ICHRA provisions: The HSA provisions would, for example, increase the HSA contribution limits for low-income and moderate-income taxpayers to up to $8,000 per year for an individual taxpayer, up from a maximum of $4,300 today, and to a maximum of $17,100 for a family, from $8,550 today.

Another HSA provision would let workers ages 55 and older put up to $1,000 per year in extra "catch up" contributions in their HSAs.

ICHRA plans let employers provide cash that workers can use to buy their own individual health coverage.

The ICHRA provisions in the One Big Beautiful Bill Act would change the name of ICHRAs to "Custom Health Option and Individual Care Expensive Arrangements," or CHOICE plans.

The ICHRA provisions would also let an employer give workers a choice between using an ICHRA to pay for individual health coverage or using fully insured group health coverage from the employer.

Today, an employer must choose between offering workers an ICHRA "cash for coverage" arrangement or offering a traditional health plan. An employer cannot let workers choose between the two types of plans.

The HSA and ICHRA changes would take effect in 2026.

The legislative details: House committees delivered their sections of the 1,116-page package, the One Big Beautiful Bill Act, to the House Budget Committee last week.

The House Budget Committee was supposed to approve the package quickly and then send it to the House Rules Committee, a powerful body that prepares legislation for action on the House floor.

Five Republican committee members — Josh Brecheen of Oklahoma, Andrew Clyde of Georgia, Ralph Norman of South Carolina, Chip Roy of Texas and Lloyd Smucker of Pennsylvania — came out against the package, arguing that it was too expensive.

The committee ended up voting 16-21 Friday against approving the package.

House leaders agreed to make the package less expensive, in part by having work requirements for Medicaid recipients take effect earlier and preventing people who are in the country illegally from getting Medicaid benefits, according to press reports.

House Budget Chairman Jodey Arrington, R-Texas, brought the committee back for a second vote on the package at 10 p.m. Sunday.

The second time around, four of the Republicans who had opposed the package Friday voted "present," rather than "no." Thanks to the shift, the committee voted 17-16 to approve a revised version of the package.

The HSA and ICHRA provisions in the revised package are almost identical to the HSA and ICHRA provisions in the version of the package that came out May 12.

The House Rules Committee is preparing to consider the package Wednesday at 1 a.m. Eastern Time Wednesday.

The committee could amend the package when it establishes the rules for the floor debate.