Published November 25, 2009
Families with special-needs children and people with chronic illnesses stand to lose hundreds, if not thousands, of dollars in tax benefits under proposed health care reform legislation, critics say, warning that a plan to cap the amount of money people can put into special "flexible spending" health accounts will have "cruel" and "unintended consequences."
The Senate and House health care bills both include a revenue-raising provision that would cap at $2,500 the amount of money workers can put into flexible spending accounts. The accounts, used by millions, allow workers to store pre-tax dollars to cover out-of-pocket health care expenses during the year.
Many employers set a cap on contributions at about $5,000, according to Save Flexible Spending Plans, a group formed by benefits providers over the summer to lobby against the changes. Federal government workers are subject to a $5,000 limit, and most state governments impose a $3,000-$6,000 cap. But legally there is currently no cap across the board.
The change is projected to bring in about $15 billion over the next decade by limiting the pre-tax dollar savings, but critics say it could have devastating effects on families that rely on flexibile spending accounts to pay for health care expenses that are not covered by their insurance policies.
"It's really become kind of a revenue grab rather than good sound health policy," said Jody Dietel, chief compliance officer for WageWorks, a company that helps administer the accounts. She is also executive director of Save Flexible Spending Plans.
Dietel said her group has succeeded in convincing Congress not to eliminate the accounts altogether, an idea that was floated, but is still pushing to raise the cap to $5,000. The group also wants the Senate bill to make sure the cap is adjusted for inflation.
Dietel's group estimates that about 35 million people use the flex accounts. She said the average deposit is under $1,500 annually, so most people -- who use the money for copays and other small-dollar items -- would not be terribly inconvenienced by a $2,500 cap.
But she said the change would be significant for those who routinely rack up out-of-pocket expenses due to chronic illnesses or special-needs children.
Policy groups estimate that people with chronic illnesses face more than $4,000 annually in out-of-pocket expenses. Flex account money can go toward that.
But the accounts have come under fire for contributing to wasteful health care spending -- something the health care reform effort is trying to curb. Because the money must be spent in a calendar year, those looking to drain their accounts may dump them on unnecessary medical expenses at the last minute.
The Center on Budget and Policy Priorities suggested eliminating the accounts altogether when the health care reform debate was kicking into high gear over the summer.
"FSAs encourage the overconsumption of health care, which runs directly counter to a critical goal of health care reform," the group said in a study, arguing that other health care reform provisions that limit out-of-pocket expenses would make FSAs less important anyway.
Ryan Ellis, tax policy director at Americans for Tax Reform, said the real pain from the new policy would be felt among families with special-needs children, who are currently able to use the money to pay for education expenses.
"The No.1 group that would be affected by this are parents of special needs," he said, citing the tuition costs at some specialized schools that climb well into the thousands.
"This is a classic case of unintended consequences," Ellis said. "And they're often fairly cruel ... This is a clear case of that."
The push for the cap came from the Senate Finance Committee, and the cap eventually made its way into both the full House and Senate bills. A representative for Senate Finance Committee Chairman Max Baucus, D-Mont., could not be reached for comment.