Abstract
This article outlines the foundations of health-related accounts and arrangements, including tax and economic considerations affecting their role in various designs for health insurance coverage. It explores the impact of the Affordable Care Act (ACA) and related administrative guidance affecting their usage, arguing that emerging trends showing that insured patients are bearing increasingly significant levels of out-of-pocket costs suggest an expanding role for consumer-directed accounts and arrangements, albeit one clouded by looming excise taxes imposed on "excess benefit" coverage beginning in 2018. It also examines the potential to utilize health accounts/arrangements to resolve moral and ethical conflicts in healthcare policy. Building on a suggestion by Professor Zelinsky, this article argues that an expanded approach to using health accounts/arrangements could enhance freedom not only for religious employers, but also for nonreligious employers concerned about respecting the religious beliefs of their employees.