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Members of the Senate Finance Committee have left health savings account and health reimbursement arrangement provisions out of their proposals for the big federal tax and budget bill.

The 549-page PDF file the committee posted Monday does include many provisions from the House One Big Beautiful Act package, such as provisions that would keep the estate tax exemption at the current level and keep it from falling about 50% next year.

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The new version would also make 529 college savings accounts more generous, establish a new type of savings account for newborn babies and change the federal workers' retirement benefits changes included in the House package.

But the new version does not mention any of the 14 HSA and HRA changes that were in the House package.

Related: 14 HSA and HRA sweeteners in the House 'One Big Beautiful' tax bill

Senate Finance Committee Chairman Mike Crapo, R-Idaho, did not talk about health account provisions when he unveiled his committee's work.

Sam Melamed, the chief executive officer of NCD, a supplemental health benefits distributor, suggested on LinkedIn that lobbyists will now be fighting to shape whatever really comes out of Congress.

But the fact that the Senate Finance version makes no mention of HSAs or HRAs at all "will make it a much harder starting position for inclusion in the final bill," Melamed predicted.

The package: The Senate Finance draft is part of an effort by Republicans in Congress to create a budget for the federal government and renew the tax rule changes created by the Tax Cuts and Jobs Act of 2017.

Back when lawmakers were drafting the TCJA, they made the tax rule changes temporary to reduce the projected impact of the changes on the federal budget deficit. Now, some of those changes are set to expire Dec. 31.

Many Democrats in Congress oppose renewing the TCJA tax rule changes.

Senate Finance Committee Republicans argue that letting the TCJA changes expire would cause the "biggest tax hike in history."

"If the 2017 Trump tax cuts expire, Americans will face a more than $4 trillion tax hike and those making under $400,000 per year will be hit hardest," according to the Senate Finance Republicans' summary of their new tax bill draft. "Permanently extending tax relief is the best way to restore prosperity and opportunity for working families."

The Senate Finance Committee is just one of the Senate committees working on portions of the Senate version of the tax and budget bill.

The Senate Banking, Housing and Urban Affairs Committee and the Senate Health, Education, Labor and Pensions Committee have also posted what they say are drafts of sections that will go in the final package.

Top Republicans in Congress have said that they hope to complete work on the package by July 4.

The CHOICE arrangement gap: One of the missing provisions could have replaced the individual coverage health reimbursement arrangement with a new type of account.

Employers can use ICHRAs to give workers cash that the workers can then spend on buying their own individual major medical coverage.

The House version of the tax bill would replace ICHRAs with "custom health option and individual care expense arrangements," or CHOICE arrangements. Today, an employer must offer all workers in a given category traditional health coverage or an ICHRA.

If the tax bill CHOICE arrangement provision came to life as written, an employer could let workers choose between taking up ordinary health coverage or using the employer cash in a CHOICE arrangement to buy individual coverage.

Other health account omissions: Some of the other health account provisions left out would increase the HSA contribution limit for low-income and moderate-income workers, let older workers contribute more to their HSAs, and let people use HSAs to pay for health club memberships and direct primary care program bills.

Reactions: House Ways and Means Committee Chair Jason Smith, R-Mo., seemed to react to the Senate Finance draft by issuing a statement about the value of the House health account provisions without directly mentioning the Senate Finance draft.

"For working-class Americans, health care costs can eat away at a family budget," Smith said in the statement. "Increased access to HSAs and health reimbursement arrangements will empower small businesses and help individuals to take control of their health care, better manage those expenses, and seek out insurance coverage that actually meets their needs."

America's Health Insurance Plans, a group for health insurers, received the Senate Finance draft while in Las Vegas for its annual meeting.

AHIP welcomed provisions in the Senate Finance draft that would keep the current level of Medicare benefits stable, but it added that the draft leaves out "meaningful HSA reforms that would provide greater choice and flexibility to employers and workers."

"As the budget reconciliation process continues, Congress should support low-income people and working families by keeping coverage stable and access to care affordable in Medicaid and the individual market," AHIP said.

The future: Health account provisions could still show up in the big tax and budget package.

The Senate Finance Committee could put provisions in its draft before formally considering it or add a health account amendment while debating the bill.

Other members of the Senate could add health account provisions while putting the package together for action on the Senate floor or after the package is already on the Senate floor.

Once the Senate passes something, House and Senate negotiators could add health account provisions while ironing out differences between their versions of the package.

Even if the health account provisions fail to return to the tax and budget package, lawmakers could later consider them outside the process for creating the tax and budget package.

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Allison Bell

Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.