Not the Next IRA: How Health Savings Accounts Shape Public Opinion

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009
This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.
http://jhppl.dukejournals.org/cgi/content/abstract/34/2/181

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.
You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.
As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.
It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009

This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.

http://jhppl.dukejournals.org/cgi/content/abstract/34/2/181

Comment:

By Don McCanne, MD

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.

You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.

As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.

It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.