The consumer-directed health care benefits community receivedsome unwelcome news from the Internal Revenue Service recently,when the agency announced its intention to impose a fee on healthreimbursement arrangements beginning in 2013.

The fee is yet another of the many provisions of the PatientProtection and Affordable Care Act that flew under the radar duringits passage as other provisions of the bill received much morepublic scrutiny. And, as with many provisions of PPACA, what thisprovision will do in practice may not have been exactly whatPPACA’s supporters had in mind.

In short, PPACA created the Patient-Centered Outcomes ResearchInstitute, a quasi-governmental think tank devoted to evaluatingthe relative effectiveness of various medical treatments andprocedures. The theory is that the PCORI will discover ways to makehealth care less expensive. Ironically, this will be accomplishedby making health plans more expensive: Plans must pay a $1 perparticipant fee to the federal government to fund the Institute.This fee may increase to $2 or more per participant in lateryears.