Supporters of the bill, primarily Republicans, say it will provide Americans with greater flexibility in health care choices and ways to pay for that health care. They say the Affordable Care Act (ACA) made health care more expensive and limited consumer choice, which further diminishes competition and increases costs. The ACA, they point out, made over-the-counter medications and health care products ineligible for coverage under HSAs and other savings account; this bill returns to the principles of the law in place prior to the ACA. Supporters say that the measure will allow participants in high deductible health care plans to access certain types of care, such as telehealth or managing chronic diseases, and will allow individuals to choose their doctors. It also gives employers additional flexibility in providing health care services for their employees, they say, and allows employees to move between employers without losing funds that have been placed in health FSAs or HRAs.

Opponents of the bill, primarily Democrats, say it further undercuts the ACA and mainly benefits wealthier individuals by giving them additional tax breaks. People who cannot afford their medical care and prescriptions cannot afford to fund health savings accounts, they say, and usually don't hold jobs where their employers fund such accounts for them. The bill simply expands the gap between the haves and the have-nots in this country. The additional tax breaks, they note, will also add to budget deficits and reduce tax revenue that could be used to improve health outcomes for all Americans. Noting the huge budget deficits created by the recently enacted tax law — which they point out also disproportionately benefited the wealthy — they say Republicans are only adding to that deficit with this bill, which will lead to attempts to cut funding for Medicare, Medicaid and the Children's Health Insurance Program in an effort to balance the budget on the backs of the poor.