Republican lawmakers are advocating for high-deductible health plans paired with government-funded health savings accounts as an alternative to Affordable Care Act subsidies. This approach aims to empower patients but has drawn criticism for leaving many with substantial medical debt. Personal stories highlight the financial burdens faced by those with such coverage.
High-deductible health plans, which require individuals to pay thousands out of pocket before insurance coverage begins, have gained renewed focus amid Republican efforts to reshape health care policy. Sen. Bill Cassidy, R-La., has suggested directing government funds to health savings accounts rather than subsidizing premiums for ACA marketplace plans. In a recent hearing, Cassidy stated, "A patient makes the decision. It empowers the patient to lower the cost."
Former President Donald Trump echoed this sentiment in a Truth Social post last month, declaring, "The only healthcare I will support or approve is sending the money directly back to the people."
These plans emerged two decades ago following backlash against health maintenance organizations, with a tax law change enabling tax-free health savings accounts for deductibles exceeding $1,650. Proponents argued that giving consumers "skin in the game" would encourage seeking lower-cost, higher-quality care, as noted by Shawn Gremminger of the National Alliance of Healthcare Purchaser Coalitions. However, Gremminger added, "The unfortunate reality is that largely has not been the case."
Today, the average deductible for job-based single coverage nears $1,700, a sharp rise from $300 in 2006. Despite this shift, U.S. medical prices have surged; for instance, knee replacements cost 74% more from 2003 to 2016, outpacing inflation. A 2022 survey indicates about 100 million Americans carry health care debt, mostly while insured.
Sarah Monroe, 43, from near Cleveland, exemplifies the challenges. Four years ago, during a twin pregnancy, she experienced fainting and was diagnosed with a heart condition, accruing over $13,000 in debt despite her high-deductible plan and modest health savings account balance. She found price shopping unfeasible amid emergencies and chose a major local health system for reliability.
Experts like oncologist Fumiko Chino at MD Anderson Cancer Center argue that complex care, such as cancer treatment, defies easy comparison. A study of over 8,000 cancer patients showed those with high-deductible plans faced higher mortality risks. Monroe's family endured relocation to a smaller apartment, depleted savings, a plummeting credit score, and vehicle repossession, forcing ongoing sacrifices. She reflected, "We can't treat people like this."