Health Savings Accounts (HSAs) are being promoted by President Bush and conservatives in Congress as a way to bring down spiraling health care costs. Only if consumers have "skin in the game," they argue, will Americans start to shop around for cheaper health care.
HSAs are tax sheltered savings accounts coupled with high-deductible health insurance policies, and they have serious drawbacks. For many health consumers, HSAs will increase out-of-pocket costs—and complexity.
And here's what they won't do: They won't bring down health care costs and they won't make a dent in the number of Americans without health insurance. This resource center pulls together a range of materials looking at the limitations of Health Savings Accounts.
Analyses of and Articles about Health Savings Accounts:
An Unequal Burden: The True Cost of High-Deductible Health Plans for Communities of Color discusses the full costs associated with high-deductible health plans and why these expenses are disproportionately unaffordable for racial and ethnic minorities. It also examines several myths about health savings accounts (HSAs), which are often coupled with such health plans. (Families USA, September 2008)
Findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey shows that HSAs have had no impact on the number of uninsured, but they have increased market segmentation by attracting wealthier and healthier people. The study also documents that individuals with HSA-coupled health insurance have lower satisfaction, face high cost-sharing, and are more likely to delay needed care due to cost. More than half of such policyholders have no first-dollar coverage for preventive services. (Employee Benefit Research Institute and The Commonwealth Fund, 2008.)
Consumer Directed Healthcare: Except for the Healthy and Wealthy, It’s Unwise, a new study completed by Harvard Medical School researchers, finds that high deductible health insurance plans are unfair to women. Because of routine medical exams, women pay an average of $1,000 more than men on health care. The study's author sums up: "High-deductible plans punish women for having breasts and uteruses and having babies."
Stop Bad Ideas—How HSAs Can Drain Your Wallet and Harm Your Health presents three examples that illustrate what can happen to employees working for a hypothetical company that purchases a high-deductible health plan. (Families USA, December 2006)
New Provision in "Tax Extenders" Bill Would Make Health Savings Accounts More Attractive as Tax Shelters describes a new law that extends HSA tax shelters, primarily benefitting the wealthy. (Center on Budget and Policy Priorities, December 7, 2006)
Stop Bad Ideas—HSAs: Missing the Target examines the effects that HSAs will have on those without health insurance and on the health care system overall. (Families USA, November 2006)
Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families finds that two of five privately insured adults who had high-deductible health plans had expensive medical bills that were not covered by insurance. (The Commonwealth Fund, September 2006)
Consumer Directed Health Plans: Early Enrollee Experiences with Health Savings Accounts and Eligible Health Plans (U. S. Government Accountability Office, GAO-06-798, August 2006)
Informing the Debate about Health Savings Accounts: An Examination of Some Misunderstood Issues (Center on Budget and Policy Priorities, June 13, 2006)
Health Savings Accounts Unlikely to Significantly Reduce Health Care Spending (Center on Budget and Policy Priorities, June 12, 2006)
Health Savings Accounts: Why They Won't Cure What Ails US Health Care (The Commonwealth Fund, June 2006)
Tutorial: Consumer-Directed Health Plans (kaiserEDU.org, June 2006)
Consumer Directed Health Plans: Small but Growing Enrollment Fueled by Rising Cost of Health Coverage includes data on enrollment and on out-of-pocket health care expenditures for people in HSA- or HRA-qualified high-deductible health plans. (Government Accountability Office, GAO-06-514, April 2006)
High-Deductible Health Plans with Health Savings Accounts: Emerging Evidence and Outstanding Issues (Missouri Foundation for Health, March 2006)
Taking a Closer Look at Health Savings Accounts explains what HSAs are and discusses their shortcomings. (The Georgia Budget and Policy Institute, March 2006)
President Bush's Fiscal Year 2007 Budget: Analysis of Key Health Care Provisions includes discussion and commentary on Health Savings Accounts (HSAs), Medicaid, and Medicare. (Families USA, February 2006)
President's Proposal Would Make Health Care Less, Not More, Affordable (Families USA Press Statement, February 2006)
President's Health Care Message Is Most Notable for What Was NOT Said (Families USA Press Statement, February 2006)
Administration Defense of Health Savings Accounts Rests on Misleading Use of Statistics (Center on Budget and Policy Priorities, February 2006)
A Second Opinion on the President's Prescription explains how President Bush’s support of HSAs constitutes another gift to the affluent and healthy and a “poison pill” to those living on the margins of society. (The Commonwealth Fund, February 2006)
Dangerous Prescription California Insurance Commissioner John Garamendi’s piece provides a more in-depth explanation of what HSAs are and what changes they will cause if implemented. (California Department of Insurance, January 2006)
President’s Health Care Tax Cut Proposals Are Likely to Weaken Employer-Based Health Insurance, Primarily Benefit High-Income People, and Worsen Deficits (Center on Budget and Policy Priorities, January 2006)
Health Savings Accounts Won’t Work for Workers (AFL-CIO, 2006)
Early Experience with High-Deductible and Consumer-Driven Health Plans lists six key problems with HSAs. (Employee Benefit Research Institute, December 2005)
Do High-Deductible Health Plans Threaten Quality of Care? (New England Journal of Medicine, September 2005)
HSAs: A Great Tax Shelter for Wealthy, Healthy People but Little Help to the Uninsured, Underinsured, and People with Medical Needs (Ethics Journal of the American Medical Association, July 2005)
The Effect of Health Savings Accounts on Health Insurance Coverage argues that HSAs will not help expand health care and may help weaken small-group health care. (The Commonwealth Fund, April 2005)
Health Savings Accounts: The Fundamentals (National Health Policy Forum, April 2005)
How High Is Too High? Implications of High-Deductible Health Plans (The Commonwealth Fund, April 2005)
Hazardous Health Care: The Impact of Health Savings Accounts on Minnesota Health Care (SEIU Local 113, March 2005)
Health Savings Accounts: Issues and Implementation Decisions for States examines the role that states will play in implementing HSAs. (Academy Health, State Coverage Initiatives, September 2004)
Most Households' Medical Expenses Exceed HSA Deductibles (Urban Institute Tax Policy Center, August 2004)
Proposal for New HSA Tax Deduction Found Likely to Increase the Ranks of the Uninsured (Center on Budget and Policy Priorities, May 2004)
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