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Health account firms are hoping that Congress will find a way to save at least some of the 11 health account provisions that showed up in an early version of the One Big Beautiful Bill Act but were left out of the version that President Donald Trump signed into law.
Some of the provisions left out could have done things like letting workers use health savings account cash to pay for gym memberships, let workers shutting down flexible spending arrangements roll some of the unused value into HSAs, and created a permanent, easier-to-use version of the individual coverage health reimbursement arrangement — the Custom Health Option and Individual Care Expense arrangement, or CHOICE arrangement.
A new CHOICE arrangement law could accelerate efforts to help employers pull back from health plan management, by simply offering employees cash that the employees could use to buy their own individual or family coverage.
Ben Light, vice president of partnerships at Zorro, an ICHRA provider, said in an email that Zorro has not seen anyone create a legislative vehicle that could be used to ferry the CHOICE arrangement proposal and other health account changes through Congress.
"It's possible that there could be a One Big Health Bill package," Light said. "There's been some chatter about the potential for a larger health package, but with the vote on the One Big Beautiful Bill having taken place only a few days ago, it's still too soon to tell how or when that might take shape."
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In theory, states with their own state-based Affordable Care Act public exchange programs could create state CHOICE arrangement laws, but although those states have generally supported ICHRA efforts, "none appear to be moving to codify CHOICE- or other ICHRA-like reforms at the state level," Light said. "They're largely waiting on federal action."
But it's possible that new health account programs could be available as early as January 2026 if Congress does pass more health account legislation by September, Light said.
Shobin Uralil, the chief operating officer at Lively, another health account firm, said he thinks firms like his will be able to begin making use of the new health account provisions that have been enacted quickly.
The provisions will:
◆ Codify existing regulations that let the high-deductible health plans that are compatible with HSAs provide free or low-co-pay telehealth services before enrollees have met their deductibles.
◆ Let workers use up to $150 in HSA cash per month to pay for individual direct primary care practice memberships and up to $300 per month for family DPC memberships.
◆ Classify bronze-level and catastrophic-level coverage as HSA-compatible, even if the high out-of-pocket spending maximums for those bare-bone plans would normally exceed the statutory out-of-pocket maximums for HSA-compatible health plans.
Lively is already using the telehealth access rules that the OBBBA package made law, and it has also implemented the new OBBBA rules that make it easier for people with bronze and catastrophic coverage to use HSAs.
Lively will be able to make use of the new HSA eligibility categories Jan. 1, 2026, Uralil said.
Uralil estimated that about 5 million to 7 million people have either bronze or catastrophic plans, and that most have bronze coverage.
Persuading many of those people to set up and fund HSAs will probably take more than one year, and the key to increasing take-up will be education, Uralil said.
"This will mirror the same education approach that is part of employer groups offering an HSA for the first time," Uralil said. "Over time, we can expect to see significant adoption."
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