Q: "I have a health savings account, or HSA, through my financial institution, where I use money from the account to pay for health care services. In all the chaos over health care reform, I haven’t heard much about its impact on HSAs. Can you shed some light on this?" - T.R., Concord, N.H.

A. The health care reform bill, enacted last March, will chip away at the façade of the health savings account, no doubt about that.

For the uninitiated, an HSA enables health care consumers to use high deductible health plans to sock money away in a savings account, tax-free, to pay for health care costs. Like any savings account, an HSA accrues interest and can roll over from year to year.

It’s the best of both worlds for health consumers who aren’t blessed with one of those public or private “Cadillac” plans that give them gold-plated coverage for no or low cost. HSAs are also highly popular with small business owners and independent contractors, who can use their health savings accounts to pay for basic medical services, and also have insurance to cover any catastrophe that might befall them.

In one way, health savings accounts should grow along with health care reform. With more Americans mandated to buy health insurance, the option to buy low-premium, high-deductible plans should be attractive to consumers. According to HealthSavingsAccounts.com, HSAs have garnered $8.6 billion in deposits in the U.S., and the website estimates that the HSA market will grow to $100 billion.

About 20,000 American companies offer health savings accounts to their employees. General Electric (Stock Quote: GE), the largest corporation in America, only offers HSAs to its workforce of 75,000 – GE cancelled its traditional health care plans in 2009.

But how will health care reform directly impact health savings accounts? In several ways, actually.

For starters, HSA holders can no longer use their account to pay for over the counter medicines like Tylenol or Prilosec. Under the new rules, only prescription drug costs can be applied to HSA funds. There is one unappealing exception: The Internal Revenue Service will allow such purchases if you get a doctor’s note of approval. This new rule will begin Jan. 1 next year.

Second, the new health care law doubles the penalty for using HSA money to pay for non-medical expenses (from 10% to 20%). That rule takes effect in 2011.

The health care law also places a cap on HSAs, to $2,500 per-year. Right now, there is no official limit on HSA contribution ceilings, although many companies cap such plans at $3,000 or $3,500. That last provision may not be such a big deal – HSAs are structured as “use it or lose it” plans, so consumers typically don’t overfund their health savings accounts, anyway.

Health savings accounts are libertarian in nature. Those with HSAs take responsibility over their own health care costs, asking for no help from the government, or from other consumers. But the new health care law has stripped some of that independence away.

So the answer to your question is this: As an HSA consumer, you were in the driver’s seat prior to the enacting of health care reform. But today, not so much.

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