President Trump has proposed giving people money for health savings accounts that are attached to high-deductible health plans, as an alternative to extending the subsidies that bring down premiums for people enrolled in Affordable Care Act (ACA) state health insurance exchanges. But, Noam Levey reports for KFF Health News that health savings accounts or HSAs have already left millions of Americans in debt. They are no solution to the rising cost of health care.
People opt for high-deductible plans because they come with lower monthly premiums. They then hope they won’t need care. If they do need care, they too often struggle to afford it. Levey tells the story of one woman with a high-deductible health plan, who became ill with a heart condition and racked up $13,000 in medical debt.
Lots of Americans now have high-deductible health plans because they are more affordable, at least from the perspective of their upfront premium costs. The problem is that the high deductibles that are attached to these health plans create a cost-related barrier to care or lead people to incur enormous debt.
In a high-deductible health plan, the annual deductible easily could be $7,000. The insurer is not required to cover any care until the enrollee spends $7,000 out of pocket. Senator Bill Cassidy, a Republican from Louisiana, argues that these high-deductible health plans give people the ability to afford health insurance. But, health insurance that creates a barrier to care is of little value.
Rejecting the proposal for Congress to extend Affordable Care Act subsidies, President Trump recently said in a post on Truth Social, “The only healthcare I will support or approve is sending the money directly back to the people.” But, this health savings account money is actually an indirect payment to the health insurers, since people must spend all of it and more before the insurer will cover their care. And, it too often forces people to choose between getting health care and ending up in debt or foregoing health care.
Three years ago, 100 million or so Americans had some health care debt. Likely, tens of millions more opted not to get care and either died or have seen their health conditions worsen. And, most of them have health insurance.
High deductible health plans do not induce people to be smart health care consumers, shopping for lower-cost care, as some would like you to believe. Going to the doctor or hospital is nothing like going to a restaurant, as most of the time you have little idea of what’s on the menu (what treatments you will receive) or what the menu items (services) will cost. Doctors choose a basket of services for a patient’s condition at the time of treatment, as they detect issues. Patients have virtually no control over those services in most situations.
One nonprofit that looks at health care costs reports that people have no control over 93 percent of their health care spending. They can shop for prescription drugs, some preventative care and some outpatient services. They cannot shop for the high-ticket treatments, such as cancer or heart care.
Here’s more from Just Care:
- Millions of Americans face higher medical bills.
- Medical debt more prevalent among Medicare Advantage enrollees than traditional Medicare enrollees
- Costs in Medicare Advantage present barrier to care
- UnitedHealth’s denials of critical rehab services is under investigation
- 2025: More older adults gamble with their health in Medicare Advantage
