Passage of the budget reconciliation bill may prompt members of Congress to take on reform of pharmacy benefit managers (PBMs), health savings accounts (HSAs), and individual coverage health reimbursement arrangements (ICHRAs). More specifically, the National Association of Business and Insurance Professionals (NABIP), along with some members of Congress, has prioritized setting federal rules for PBMs, creating a statutory framework for ICHRAs, and increasing the flexibility of HSAs and flexible spending arrangements (FSAs).
While the new tax bill maintained the tax exclusion for employer-sponsored health benefits and made some small changes to HSAs, NABIP maintains that further reform on these issues is necessary. Some predict that the House GOP will be particularly motivated to pass ICHRA legislation, which currently is based on regulations, not federal law.
While conservative Republican members of Congress had hoped to include various provisions affecting health insurance and medical expenses, very few such provisions were included in the final version of the law after the Senate removed most of the related provisions from the bill. The new law on HSAs permits participants to spend a certain capped amount toward direct primary care membership, which allows basic medical care for a monthly access premium. Workers with high-deductible plans also will be able to use HSAs, even if the annual out-of-pocket spending cap for healthcare coverage is greater than for HSA-compatible coverage. Finally, an HSA-compatible health plan can now offer telehealth services as part of pre-deductible coverage.
Aside from the ICHRA provisions, the final version of the bill omitted various other health account provisions, which might lead to members of Congress submitting bills to address them. These provisions, some of which were part of the original House bill, include allowing HSA funds to pay for gym memberships, permitting workers 65 and over with Medicare Part A coverage to continue contributing to HSAs, and letting workers roll at least some unused funds from FSAs or discontinued HRAs into HSAs. Other potential legislation might increase HSA contribution limits and allow workers with spouses who have FSAs to still contribute to HSAs.
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