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The Hidden Gem of US Health Care Policy: Health Savings Accounts
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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.
As we enter an election year, physicians and patients may wonder how policy changes may affect the delivery of health care. Dermatologists may wish to support an underrated aspect of US health care that enjoys broad popularity: the expansion of health savings accounts (HSAs).
What are HSAs?
HSAs were initially established in 2003 as a component of the Medicare Prescription Drug, Improvement, and Modernization Act.1 Their prevalence has surged over the past 2 decades, particularly as more employers have adopted high-deductible health plans in the wake of the 2010 Affordable Care Act. Many patients often do not hit their yearly deductible, so any money spent on premiums is effectively wasted because their insurance does not kick in. Patients in these situations may skip medications or forgo necessary medical care to cut costs. HSAs are designed for precisely these situations.
HSAs are valuable due to their status as “triple tax-free.” In other words, you may deposit a tax-deductible contribution each year, which remains untaxed, and withdraw the funds untaxed in the future. People may use funds in their HSA for a variety of health-related expenses, including many aspects of dermatologic care that may not be covered by traditional insurance plans. Although HSAs are widely popular, current legislation only allows a small percentage of the population (those with high-deductible health plans) to use them. Even among this group, most people do not maximize their contributions.2
Expanding HSAs
Proposed legislation would expand HSAs to all Americans, while increasing contribution limits and expanding the services for which HSA funds are eligible, including insurance premiums and membership fees for direct-pay health practices.3 Depending on these new definitions, this legislation has the potential to be a boon to dermatologists.
Patients who previously could not afford certain medications or procedures may instead dip into HSA funds without the delays in care caused by prior authorizations. Dermatologists may be empowered to prescribe the most effective treatments immediately rather than forcing patients to undergo step therapy. Additionally, we may make increased use of compounding and specialty pharmacies, which would cut out middlemen and reduce the influence of pharmacy benefit managers and other drivers of health care costs.
Dermatology practice owners may also enjoy the increased flexibility of expanded HSAs when offering health insurance to their employees. These accounts would now be available to all without forcing the employer to subscribe to a high-deductible group health plan.
Conclusion
In this era of rising inflation and decreasing reimbursement, dermatologists must seek creative ways to provide excellent care while ensuring that patients maintain access to our services. The expansion of HSAs is an underrated but hugely beneficial policy proposal that enjoys popular support among our patients.
Dr Hussain is a dermatologist in private practice in Northern Virginia.
Disclosure: The author reports no relevant financial relationships.
References
1. H.R.1 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003. December 8, 2023. Accessed February 1, 2024. https://www.congress.gov/
bill/108th-congress/house-bill/1
2. Kullgren JT, Cliff EQ, Krenz C, et al. Use of health savings accounts among US adults enrolled in high-deductible health plans. JAMA Netw Open. 2020; 3(7): e2011014. doi:10.1001/jamanetworkopen.2020.11014
3. H.R.9160 - Healthcare Freedom Act of 2022. December 7, 2022. Accessed February 1, 2024. https://www.congress.gov/bill/117th-congress/house-bill/9160/text?s=1&r=1
