Tuesday, August 25, 2009

Alphabet Soup Under the Bus?

In our coverage of the swine flu vaccine, we mentioned in passing that it may be eligible for reimbursement under what we call "flex ben" plans (HSA's, HRA's and FSA's). In researching that post, my "guru" for all things flex mused about the fate of what he calls "the alphabet soup" under "health care reform." There seems to be a lot of speculation, but not much hard evidence regarding how these plans will fare.
So, of course, we'll add to that speculation:
First, I could find no mention of any of these plans in the "American Health Choices Act." The only item that remotely touches on them is the requirement that new plans must be "qualified," and I doubt very much that an HSA plan would, um, qualify. Of course, "absence of evidence is not evidence of absence," so it may well be that some enterprising bureaucrat, tasked with actually implementing the bill, would see fit to throw flex plans out under one or more such criteria.
So-called "cafeteria plans" are one benefit of group based coverage; this is a system where a (usually larger) employer offers an array of products from which the employee can choose. Since one of the funding mechanisms for "reform" is a tax on "richer" plans, we may well see those go away, reducing choices and, perhaps, availability of cafeteria plans altogether.
One thing that appears certain is that reimbursement for over-the-counter med's will go away; that is, they will no longer be considered an eligible expense. I'm not convinced that this is a horrible thing: it's a relatively new benefit to begin with, and it's unclear how many people even know about it, much less take advantage of it.
Since one of the primary stumbling blocks facing "reformers" is how to pay for their plans, a number of insurance products are in the crosshairs (e.g. Medicare Advantage); it seems reasonable to presume that doing away with tax advantaged programs like HRA's and FSA's would be a quick and easy way to raise funds. Since these aren't insurance products in and of themselves, getting rid of them may be an easier sell to the public, most of whom don't utilize them anyway.
It's difficult to find credible information about the fate of these benefits, so we'll keep looking, and update as appropriate.
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