Now that President Donald Trump has signed the 870-page One Big Beautiful Bill Act tax and spending package into law, members of Congress may renew the fight to pass major pharmacy benefit manager, health savings account and health reimbursement arrangement bills.
Activity could heat up for bills that would:
◆ Set federal rules for pharmacy benefit managers.
◆ Put the framework for individual coverage health reimbursement arrangements, or ICHRAs, in federal law.
◆ Make health savings accounts and flexible spending arrangements more flexible.
The National Association of Business and Insurance Professionals has already put those items on a list of “remaining priorities for congressional action.”
Jessica Brooks-Woods, NABIP’s chief executive officer, said in a statement that the new tax law maintains the current federal income tax exclusion for employer-sponsored health benefits and does include some HSA provisions.
But “we will continue to advocate for policies that protect and empower health care consumers and the professionals who serve them,” Brooks-Woods said.
Brian Gilmore, the lead benefits counsel at Newfront, an insurance broker, predicted that House Republicans will be especially eager to pass an ICHRA bill.
The OBBBA backdrop: A few weeks ago, Rep. Chip Roy, R-Texas, and other conservative Republicans in the House Freedom Caucus were hoping that the “OBBBA” package would pull a long list of health policy bills through Congress and onto Trump’s desk.
But the version that Trump actually signed Friday contained only a few provisions with a direct effect on ordinary commercial health insurance.
The final version of the law excluded most of the health savings account and health reimbursement arrangement provisions that were in a version passed by the House in May.
The new law does include a provision that will let HSA owners spend up to $150 per month for an individual direct primary care membership and up to $300 per month for a family membership.
Direct primary care practices offer what amounts to access to basic health care services for patients who pay health care access dues in advance.
The new law also makes it easier for workers to use HSAs together with bare-bones bronze plans or catastrophic-level plans, by classifying that type of coverage as compatible with HSAs even when the annual out-of-pocket spending limit for the coverage exceeds the usual annual out-of-pocket spending cap for HSA-compatible coverage.
A third section in the new law confirms that an HSA-compatible health plan can offer pre-deductible coverage for telehealth services.
ICHRAs: Employers can now use ICHRAs to create “cash for coverage” health plans. Employees can take the cash an employer has put in the ICHRAs and buy their own individual health coverage.
But ICHRAs are based on regulations, not only federal law.
A provision in the version of the OBBBA package that the House would have put the ICHRA rules in federal law and made ICHRAs somewhat more flexible and easy to administer.
Punchbowl News last week obtained a leaked memo showing that members of the House Freedom Caucus, a group for very conservative Republican House members, put the health account provisions that actually made it into the final version of the new tax law on a list of “Senate OBBBA failures.’
The Senate cut out most of the House health account provisions, “wasting a once-in-a-decade opportunity to delivery more health care freedom for Americans,” according to the leaked memo.
The omission of the ICHRA provision was “clearly a major disappointment to the burgeoning ICHRA industry,” according to Gilmore.
Other health account provisions: Gilmore noted that some of the other health accounts provisions that were left out — and could be ripe for congressional action now — would:
◆ Let HSA holders use some HSA cash to pay for gym memberships.
◆ Let workers who turn 65 and enroll in Medicare Part A coverage continue to contribute to HSAs.
◆ Let workers with discontinued flexible spending accounts or discontinued health reimbursement arrangements roll at least some of the unused value into HSAs.
◆ Let a worker with a spouse with an FSA contribute to an HSA.
◆ Increase HSA contribution limits.