WASHINGTON—Some may wonder why health care reform legislation contains a provision that would eliminate the ability of employees with flexible spending accounts, health reimbursement arrangements and health savings accounts to use them to pay for over-the-counter medications.

Benefit experts say there is no apparent policy reason beyond the need to raise revenue, but say the OTC provision illustrates how health reform measures moving through Congress have become magnets for proposals that have little, if any, connection to the core of the bills.

Attaching unrelated provisions to broader bills is a time-honored practice by federal legislators and their staffs who realize the chances of winning passage of bills can increase greatly if those proposals are attached to broader, high-priority legislation, such as that designed to bring the United States closer to universal health care.

The health reform bills, noted Gretchen Young, vp-health policy with the ERISA Industry Committee in Washington, are fast-moving measures.

The problem that can occur when unrelated provisions are attached to broader bills is that the provisions don't always get the attention and scrutiny they would if they were free-standing measures.

One classic example occurred in the mid-1980s when legislators attached a free-standing bill—introduced by California Democratic Reps. Pete Stark and Henry Waxman to require employers to continue health care coverage for employees who quit or were let go, as well as dependents who otherwise would have lost group coverage due to death, divorce or marital separation—to a broader, must-pass budget bill.

When that budget bill later passed, few employers knew that it contained the health care continuation provision, which soon simply became known as COBRA, short for the Consolidated Omnibus Budget Reconciliation Act of 1985, the name of the broader bill. Many employers then had to scramble to comply with the COBRA provisions.

As for undetected benefit bombshells for employers and employees in the current health reform legislation, Ms. Young said: “Who knows what yet will be discovered?”

But given the size of the reform measures—the House bill is more than 1,000 pages—the odds are high that they contain potential benefit time bombs.

Some potentially troubling provisions and others unrelated to the core of the legislation already have been uncovered (see box).

For example, the House bill includes a provision that would bar employers with retiree health care plans from cutting benefits to current retirees unless they did the same for employees.

Employers would be locked into those arrangements and the net result would be a rush by employers, wherever possible, to terminate retiree health care plans before the provision took effect, experts say.

“It is a terrible provision. Effectively, employers would be locked in forever. Employers would have no incentive to offer the plans” and some would want to fold those plans as soon as possible, Ms. Young said.

“Employers would rush to get out of those plans,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.

If adopted, other provisions in the House bill could have a huge impact on benefit programs. For example, the House Education and Labor Committee tacked on a provision—proposed by Rep. Dennis Kucinich, D-Ohio, that would remove a barrier that now blocks states from enacting single-payer health systems.

Under current federal law, ERISA preemption bars state laws that relate to employee benefit plans. The Kucinich amendment would exempt state single-payer laws from ERISA pre-emption.

But the reason that some panel members—including 13 of the panel's 19 Republicans—voted for the amendment was not because they endorse single-payer systems, but because, benefit lobbyists said, is that the legislators believe the addition of the provision will reduce support for the overall bill, which Republicans oppose. So-called poison-pill amendments also are a tactic occasionally used to try to thwart legislation.

Like the budget legislation of the mid-1980s, the House health care reform bill also packs a COBRA provision.

The most recent addition, introduced by Rep. Susan Davis, D-Calif., and added to the reform bill by the Education and Labor Committee, would allow COBRA beneficiaries whose coverage runs out to retain COBRA until they become eligible for group coverage under a new employer's plan or until they become eligible for coverage through new state health insurance exchanges, which the legislation would establish starting in 2013.

As a result, COBRA beneficiaries could extend COBRA for years after their eligibility under current law expires. Under current law, employees who terminate employment are entitled to up to 18 months of COBRA coverage, while employees' dependents can obtain up to 36 months of coverage in situations involving death, divorce or marital separation.