The Patient Protection and Affordable Care Act was signed intolaw by President Obama on March 23, 2010, but the vast changes thelaw intended to bring about—many of which impact consumer-driven health plans—are to be phased in gradually over aperiod of eight years ending in 2018.

Last year ushered in a total of 20 new of the new provisions (17are effective), and some of these will impact CDHPs. One change hasalready had an effect on the benefits that can be offered byaccount-based consumer-driven health plans. Effective Jan. 1, 2011,a health reimbursement account, a health flexible spending account,a health savings account or an Archer medical savings account couldno longer be used to cover the costs for over-the-counter drugs notprescribed by a doctor. At the same time, the law also increasedthe tax on distributions from a HSA or an Archer MSA that are notused for qualified medical expenses from 10 percent to 20 percentof the amount used.

Some good news for the future of CDHPs came in 2011 with thefunding of state health insurance exchanges. These exchanges golive in 2014 and promise to facilitate the purchase of insurance byindividuals and small employers. An HHS Internal Memo from February2011 spelled out that CDHPs and HSAs would be available on thestate exchanges. According to the document, “The new State-basedExchanges will offer individuals, families and small businesses awide range of plans from lower-cost consumer-driven health plansand those coupled with (HSAs) that tend to have a higherdeductibles and higher cost sharing to more comprehensive planswith lower out-of-pocket costs.”