This bill proposes significant reforms to Health Savings Accounts (HSAs) by amending the Internal Revenue Code of 1986. A key provision introduces an income limitation on deductible contributions, reducing the allowable deduction for taxpayers whose modified adjusted gross income exceeds specified thresholds, such as $300,000 for joint filers. This aims to restrict the tax benefits of HSAs for higher-income individuals by phasing out the deduction. The bill also repeals the exception that allowed penalty-free distributions from HSAs after age 65 for non-qualified medical expenses, meaning all distributions must now be for qualified medical expenses to avoid penalties. Furthermore, it limits reimbursements for medical expenses to those distributed within two years of the expense being paid and requires robust substantiation for all claimed qualified medical expenses, including specific criteria for provider opinions. Certain expenses, such as spa and beauty treatments, are explicitly excluded, and exercise equipment purchases are capped at $500 annually. To address consumer costs, the legislation establishes an excise tax on excessive HSA fees charged by trustees, defining excessive as any amount exceeding a reasonable fee to be determined by the Secretary. Trustees will also be required to report detailed information on these fees, including the number and aggregate amount charged per category. Additionally, HSA reports must now include the average yield on cash balances within the account and the national average yield on savings account balances, enhancing transparency for account holders.