February 17, 2017


A small HSA fix could produce big results (James C. Capretta, February 17, 2017 | Real Clear Health)

As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in.

The combination of high-deductible insurance with HSAs is central to a market-driven reform of U.S. health care. High-deductible health plans (HDHPs) and HSAs have worked to lower costs in the employer setting by 7 to 22 percent below what would have occurred in more traditional insurance. The emerging GOP plan should include provisions encouraging employers to offer HSAs to their workers.  It should also ensure that consumers in the individual insurance market have ready access to them, and that HSAs are incorporated directly into the Medicare and Medicaid programs.

There is, however, a problem with existing HSA policy that must be fixed if HSAs are to reach their full potential in improving the efficiency of health care arrangements: As currently structured, HSAs are not built to provide easy access to care from well-organized systems of health care. Rather, HSA enrollees buy services on a fee-for-service basis, which is, in most cases, a much less efficient way of getting needed care. [...]

The rules governing HSAs should be modified to allow account holders to buy access to care from integrated care systems on a fixed-fee basis. For instance, it should be possible for an account holder to pay a fixed monthly fee to an integrated system for a pre-arranged package of services. In the typical case, these services would likely include access to the normal spectrum of physician-directed primary and preventative care, along with some coverage for prescription drugs and diagnostic tests. 

Posted by at February 17, 2017 6:04 PM