To determine what works in providing medical care, the Affordable Care Act health care reform law created the Patient-Centered Outcomes Research Institute (PCORI). For seven plan years, PCORI will be funded with fees on plan sponsors of self-insured plans, including retiree-only and COBRA plans. Now comes news that sponsors of insured plans that offer employees health reimbursement arrangements (HRAs) and certain health flexible spending accounts (FSAs) must also pay fees.