All Americans should have the right to save for current and future healthcare expenses with pre-tax dollars. Health Savings Accounts provide some Americans with precisely that opportunity, but it is too limited in its scope to benefit the majority of the US. I love the concept of Health Savings Accounts (HSA), if you’re not familiar with them they are savings accounts in which money can be put away for future medical expenses on a pre-tax basis. In order to be eligible for an HSA you must be covered under a qualifying high deductible health insurance plan (HDHP). These are health insurance policies that typically cost less because they require their holders pay a high deductible (typically greater than $1000 annually). Unfortunately, the eligibility requirement to participate in a health savings account precludes the majority of the population from receiving a privilege that should be as basic as saving for one’s own retirement.
In a recent response from my Congressman, he suggested I consider using a sister product, the Flexible Spending Account (FSA). Although beneficial, the benefits of an FSA fall short of the benefits in an HSA; primarily because the balance of unused money in an FSA expires annually where an HSA rolls over from year to year. This is a monumental difference. With an HSA I have a means to cover current and future medical expenses which can accumulate to a retirement vehicle which becomes available for any purpose at age 65. The rollover benefit becomes an even greater benefit when you consider the funds in Health Savings Account are eligible to pay the premiums on Cobra. Contributing to an HSA provides financial resources to use should one lose their job. Americans can use their HSA to pay the necessary 102% of their health premiums through COBRA or they may roll the money into a less expensive high deductible health plan (HDHP) with the resources to meet the high deductible.
Let’s look at a couple of case studies.
Dick and Jane
Dick and Jane are engaged. Jane has been submitting $2600 into and HSA for the past five years. During that time she has only consumed $1600 in health care costs that means Jane has been able to build up a health nest egg of $11,400. After they are married Dick begins carrying Jane as a dependent on his health care plan which does not qualify as a high deductible health care plan. Under current laws, Jane would be forced to discontinue contributing to her HSA, but it if all Americans were eligible for this savings incentive she wouldn’t have that problem. Instead they could increase their contribution $5,150. After a year, Dick may lose his job, but the family has been able to save $16,550. Their healthcare nest egg provides Dick and Jane with additional options. They may select to continue their current coverage through COBRA or they can select an alternate health care option. If COBRA were to cost $400 a month they can utilize their HSA funds. With these funds they would have the means of paying for coverage for 41 months. They could also choose to purchase independent health coverage. Their $16,550 nest egg minimizes their risk on a high deductible healthcare plan. They could conceivable absorb a $10,000 deductible and reduce their monthly payment to about $200, or half the cost of their cobra payment.
Scott and Laura
In the scenario of Scott and Laura, Scott is a severe asthmatic. His condition leads to a hospital stay about once a year costing about $3000. He must also have continuing medication at a monthly cost of $112. Scott and Laura are both on her employer’s group health plan. They pay $112/month with a $500 deductible and a 20% coinsurance. Their annual healthcare responsibility is approximately $2610 with insurance or approximately $4340 without insurance. Their insurance saves them approximately $1700 annually from paying full price on their medical care. Their FSA saves them about 20% (their tax bracket) on their prescription charges. Because Scott and Laura will lose the money in the FSA if they don’t spend it by the end of the year, they only save the cost of Scott’s prescriptions. Now, if Laura loses her job their healthcare future becomes much less secure because Laura’s plan was not HSA eligible, they do not any residual savings from their health care expenses nor were they granted guaranteed tax savings from their medical expenses. If they keep the medical insurance they clearly need through COBRA they now need to pay $400/month. These annual premiums total $4000 alone meaning that Scott and Laura only save about $340 a year by having health insurance. This does not include the cost of any of the co pays. Keeping the insurance could increase their medical expenses to about $6000 a year or $550/month at a time when the family income has been reduced. Scott and Laura have a very difficult choice to make in regards to their healthcare. Should they continue with coverage or should they let the family health insurance lapse?
Had they been able to contribute to an HSA, their scenario may have looked a little different. Scott and Laura would still have the same policy but chose to contribute the maximum allowable to their HSA. From the $5150 they withdrew $2610 for healthcare expenses leaving $2540 to accumulate over for the next year. Over the course of 5 years they have accumulated $12700 in the HSA. If Laura loses her job their options look much more promising. They can more easily absorb costs of COBRA and provide for the costs of their existing coverage for their entire 18 month term of eligibility. By making wise decisions in time of plenty, Scott and Laura would be able to prevent financial devastation or public dependence in the future and still provide the means to maintain their health needs. All health consumers should have the option to participate in an HSA and receive the corresponding tax benefits. The opportunity to participate in an HSA should not be tied to a high deductible health insurance plan. As it is written an HDHP with an HSA discriminates against most Americans, namely, consumers whose employers don’t offer a qualified high deductible healthcare plan and those who may have regular health needs which require a more generous health plan including young families who may need maternity or well child care.
Ironically, those ineligible to participate are doubly discriminated against. Not only do they lose the opportunity to financially prepare for the future healthcare needs, but it actually results in having higher healthcare costs. Here’s how:
1. High deductible health care plans often attract the healthiest segment of society, and when you remove the healthy consumers from the general insurance pool, rates rise to cover the lost revenue and higher payout per consumer.
2. Non participants must pay deductibles and uncovered health care from post tax dollars or they must try to forecast their annual health expenses through a flexible spending account (FSA). If they underestimate, they are again paying for expenses with post-tax dollars and if they overestimate they lose the unspent balance.
3. Individuals who have continuing healthcare needs are at the mercy of their employer for continued coverage. The loss of employment often means the loss of health care and can bring great personal risk and financial hardship.
By eliminating the requirement that an individual have a HDHP plan, you open the door for many more participants. These are people who need to hedge against risk in their health and financial well-being. When you allow people to pay their insurance premiums with their HSA, you grant them a means of planning for their health future, without discriminating based on their health care needs. Nationally, you increase the savings rate, sending more money into banks, and driving down your uninsured among the unemployed. Fewer people are dependent on government healthcare subsidies because they were able to plan during times of plenty. You open a door for increased retirement savings and, by giving people access to their funds when healthcare is needed, you limit some of the draw on government resources because they don’t end up on state sponsored plans.
All Americans should have the right to save for current and future healthcare expenses with pre-tax dollars.