A close observer of the health care consumerism movement was somewhat surprised by the reaction to his bold prediction that a proposed elimination of health reimbursement arrangements (HRAs) from private health exchanges for most active employees would sabotage this model.

Greg Scandlen, an independent health care analyst based in Hagerstown, Md., who founded Consumers for Health Care Choices, noted in a recent blog that people he respects and admires were about evenly split on his premise – and equally spirited about their convictions.

“This is not an easy subject and it will not be resolved here,” he exclaimed in a recent follow-up blog, which mirrored comments made to Employee Benefit News about a frequently asked questions (FAQ) bulletin jointly issued the U.S. Health and Human Services, Labor and Treasury departments.

He also likened the FAQ and Affordable Care Act to another piece of landmark legislation involving employee benefits, given their size, complexity and “poorly written” directives: “Most likely, if the law survives, it will be like ERISA and endlessly litigated.”

Scandlen also apologized for incorrectly assuming that Aon Hewitt’s Corporate Health Exchange uses HRAs, noting that their approach “seems to be more a multi-choice employer plan with a wider array of choices and a fixed contribution.” Ken Sperling, Aon Hewitt’s national health exchange strategy leader, had pointed out the mistake and hastened to add that “employer subsidies are expressed as ‘credits,’ and as such are not subject to the recent guidance.”

Also cited were comments by Rick Lindquist, president of Zane Benefits, Inc., who noted that “a recent set of FAQs published on the Department of Labor website has created enormous confusion regarding Health Reimbursement Accounts. If you were wondering, Can Health Reimbursement Accounts Still Reimburse Premiums, the answer is yes.”

Scandlen also addressed blog comments on HRA premium payments and a public exchange tax subsidy. “Actually,” he wrote, “it never occurred to me that anyone would use the HRA to pay for public exchange coverage. I have been assuming this would all take place in a private exchange.”

Shutan is a Los Angeles freelance writer.

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