Health Savings Accounts Work
by Michael F. CannonMichael F. Cannon is director of health policy studies at the Cato Institute.
Added to cato.org on February 9, 2006
This article appeared on Philly.com on February 5, 2006.
In December 2003, President Bush
signed a health-care law that had two major components. The first was the new
Medicare prescription drug benefit that took effect last month. That big-government
program has been widely panned as a disaster. The second was a new health
insurance option called health savings accounts, or HSAs, which became
available in January 2004.
Unlike the Medicare drug program,
the response to HSAs has been overwhelmingly positive. In just two years, three
million Americans have signed up for an HSA. More than one-third of HSA
enrollees were previously uninsured, which means HSAs already may have reduced
the number of uninsured by 1 million. Deloitte Consulting L.L.P. reports that,
for two years running, insurance premiums for HSAs and similar plans rose at
about one-third the rate of increase for other types of coverage.
So in his State of the Union
address, Bush proposed expanding and enhancing HSAs. His new Medicare
entitlement? He didn't even mention it. Go figure.
Fortunately, his HSA proposals would
make health coverage and care better and more affordable for hundreds of
millions of Americans.
HSAs couple high-deductible health
insurance with a tax-free savings account (the HSA) for out-of-pocket medical
expenses. Individuals and/or employers can contribute money to HSAs tax-free up
to the amount of the insurance deductible. HSAs must be coupled with insurance
that has a deductible of at least $1,050 for individuals and $2,100 for
families.
HSA funds may be withdrawn tax-free
for any medical expenses. Once expenses reach the deductible, insurance takes
over. Any funds that remain in the HSA roll over from year to year and grow
tax-free.
Right off the bat, HSAs save money
because high-deductible insurance is cheaper than low-deductible coverage. The
Kaiser Family Foundation reports that the difference in premiums between the
average HSA-compatible policy and the average for all types of insurance is
$1,324. That is more than enough savings to cover the average annual HSA
deductible ($1,901) in just two years. Sometimes, the savings covers the entire
deductible in the first year.
HSAs also let consumers control more
of their health-care dollars and decisions. Since consumers own the money that
covers their out-of-pocket expenses, they can see any doctors they like,
whenever they like. At the same time, patients scrutinize their medical bills
and their doctors' recommendations more carefully because it is their money on
the line.
The chronically ill, however, likely
would use up all their HSA deposits in a given year and have little opportunity
to save for future medical needs. Even with HSAs, consumers without access to
employer-sponsored insurance still pay a hefty tax penalty when they purchase
health insurance on their own.
To address those problems, the
President proposes essentially doubling the limits on HSA contributions and
allowing people to purchase health insurance with tax-free HSA funds. The
higher contribution limits ($5,250 for individuals and $10,500 for families)
would help the chronically ill and their families by allowing them to put more
money aside tax-free for their medical needs. Allowing HSA funds to purchase
health insurance would provide tax equity to millions who are unfairly punished
by the tax code.
Critics claim that HSAs are only
good for the healthy or wealthy. If true, that would mean HSAs benefit only
about 80 percent of the population. Not bad, that. But in fact,
eHealthInsurance.com reports that half of HSA enrollees are over 40 years old,
20 percent earn less than $35,000, and 40 percent earn less than $50,000.
Unfortunately, the President's
proposals are unnecessarily complex and would continue to restrict HSAs to
those who purchase high-deductible insurance. There is no reason why HSA
holders should not be able to choose their health plan themselves.
Nonetheless, Bush has made a solid
proposal that would improve the quality and affordability of private-sector health
insurance and medical care. As for Medicare, well...
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