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

The fee is yet another of the many provisions of the Patient Protection and Affordable Care Act that flew under the radar during its passage as other provisions of the bill received much more public scrutiny. And, as with many provisions of PPACA, what this provision will do in practice may not have been exactly what PPACA’s supporters had in mind.

In short, PPACA created the Patient-Centered Outcomes Research Institute, a quasi-governmental think tank devoted to evaluating the relative effectiveness of various medical treatments and procedures. The theory is that the PCORI will discover ways to make health care less expensive. Ironically, this will be accomplished by making health plans more expensive: Plans must pay a $1 per participant fee to the federal government to fund the Institute. This fee may increase to $2 or more per participant in later years.