Health Savings Accounts are the answer


As election season nears its conclusion we finally have some basic policy direction from both candidates with respect to health insurance reform and their worlds could not be farther apart.  Watching the steady decline of willing insurers and the ever increasing cost of policies in the exchanges, the Clinton campaign has voiced its support for a so-called “public option”, the holy grail of democrats’ quest for a single-payer system.

The Trump campaign, channeling its one-time rival, Dr. Ben Carson, has doubled down on Health Savings Accounts (HSAs), the health-insurance-as-401(k) product the Affordable Care Act (ACA) was supposed to extinguish but which was specifically saved by President Obama in order to provide Americans with a health insurance option they could actually afford.

{mosads}It behooves us to measure or at least calibrate how each candidate’s plan might affect the industry currently supporting the health insurance needs of almost thirty million Americans.

Fundamentally, this question is about what powers Congress has delegated to the executive branch and if they are sufficient to enact each candidate’s policies absent having to obtain further congressional authority.

For Trump, one obvious advantage is that HSAs pre-date the ACA and were embraced by it. Further, the ACA specifically delegates the important job of defining what is and what isn’t health insurance to the Department of Health and Human Services (HHS). President Trump could use that authority to greatly expand the role of HSAs in the exchanges and in entitlements, limited only by changes in budget such revision might entail.

In addition, both candidates would first have to address what Republicans are calling the insurer bail-out, the system of payments the ACA authorizes to insurers if their annual financial performance is harmed by a disproportionate number of relatively sicker enrollees in their pool. President Trump and congressional Republicans will likely use this opportunity to exact specific changes – expanding HSAs and allowing cross state insurance sales comes to mind – while President Clinton would have to convince Republicans to pay a bill they don’t want to pay and embrace a policy both they and their Democratic colleagues have already voted down. President Clinton would also have to reconcile her opposition to the Cadillac Tax, a rare example of consensus both with Mr. Trump and between both parties in Congress, with the public option’s staggering price tag.

How, exactly, can you support a system of subsidized premiums in a public health plan and oppose the revenue mechanism upon which such a plan would necessarily rely?

And, what do you say to those who have genuinely embraced the horror of unfunded retirement health care costs? HSAs are the only plan in America that allows you to save on a tax advantaged basis; Americans insured through HSAs are in a much better position for retirement than people with other coverage precisely because they have saved for it. Every other health insurance product leaves the purchaser with nothing at the end of the year.

The public option has been debated a long time. It made a cameo appearance in the 2009 debate over the ACA, when Democrats controlled both house of Congress with large majorities, but even then, it was set aside in the face of massive bi-partisan opposition. While a future debate might turn out differently – Medicare for all is not just Sen. Bernie Sanders’ presidential campaign platform but a very popular notion among House Democrats too – expectations for the 2016 congressional races will likely result in a Republican House and a Democratic Senate, severely limiting the ability of either President Clinton or President Trump to enact their agenda.

Accordingly, both candidates will have to make do with either their existing authority or by accepting opposition suggestions to get what they want. Put that way, which candidate do you think is better at the “Art of the Deal?”

Dan Perrin is President of the Health Savings Account Coalition.

The views expressed by authors are their own and not the views of The Hill.

Tags Bernie Sanders

More Healthcare News

See All
See all Hill.TV See all Video