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Legislative update: Ways and Means approves health-related tax bills

Ways and Means approves health-related tax bills

The U.S. House Committee on Ways and Means on October 23, 2019, approved the following four health-related tax bills:


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  • H.R. 4742 [PDF 39 KB] the Protecting American Lungs Act—a bill to amend the Internal Revenue Code of 1986 to impose an excise tax on nicotine used in “vaping, etc.” The tax generally would be imposed on nicotine that has been extracted, concentrated, or synthesized (subject to certain exceptions). The bill was approved by the committee 24-15.

Proposed new vaping excise tax: H.R. 4742 (the vaping excise tax bill) would tax nicotine in vaping at the same rate as small cigarettes—that is, a tax of $50.33 per 1,810 milligrams of “taxable nicotine.” The bill specifically excludes any FDA-approved nicotine replacement therapies and exempts other nicotine products already subject to tax. The manufacturer of the taxable nicotine would be liable for the tax, and the tax would be administered by the Alcohol and Tobacco Tax and Trade Bureau. The occupational tax would also apply to manufacturers of taxable nicotine under the bill.

  • H.R. 4716 [PDF 34 KB] the Inhaler Coverage and Access Now (I CAN) Act—a bill that would allow a high deductible health plan to provide certain inhalers, or related medicines delivered through such inhalers, without satisfaction of the minimum deductible. The bill was approved by voice vote.
  • H.R. 1922 [PDF 268 KB] the Restoring Access to Medication Act of 2019—a bill that (among other things) would amend the definition of qualified medical expense for health flexible spending arrangements (FSAs) and health reimbursement arrangements (HRAs) to permit reimbursements for expenses incurred for over-the-counter medicine and menstrual care products. The bill was approved by voice vote.
  • H.R. 3708 [PDF 355 KB] the Primary Care Enhancement Act of 2019—a bill under which a direct primary care service arrangement would not be treated as a health plan that would make an individual ineligible to contribute to a health savings account. The bill was approved by voice vote.


Text of the bills and text of the amendments are available on the Ways and Means website.

The Joint Committee on Taxation released the following documents in advance of the Ways and Means action:

H.R. 4742

  • A description of H.R. 4742 (relating to vaping excise tax): JCX-44-19
  • A description of a chairman’s amendment in the nature of a substitute to H.R. 4742: JCX-48-19

H.R. 4716

  • A description of H.R. 4716 (relating to inhaler coverage): JCX-45-19
  • A description of a chairman’s amendment in the nature of a substitute to H.R. 4716: JCX-49-19

H.R. 1922
  • A description of H.R. 1922 (relating to qualified medical expense definition): JCX-46-19
  • A description of a chairman’s amendment in the nature of a substitute to H.R. 1922: JCX-50-19

H.R. 3708

  • A description of H.R. 3708 (relating to primary care services): JCX-47-19
  • A description of a chairman’s amendment in the nature of a substitute to H.R. 3708: JCX-51-19

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