Given that the insurance pools are supposed to be operating in 2014 under current law, and who knows what will/won't be changed, overturned, rewritten, etc. I wouldn't worry too hard about this if you aren't retiring in the next 3 years. Too much uncertainty to get good and worried about specifics yet. Regardless, it's probably worth hedging your bets with a HSA account if you are able - one way or another you should be able to use that money for your health costs out of pocket, and the more you have saved that way, the bigger a margin for error you can work with comfortably.