HSA's in the Crosshairs

Tuesday, April 5, 2016
Apparently, Health Savings Accounts (HSAs) - or at least some versions of them - died last month:

"[F]inal regulations published on March 8 will make it impossible to offer HSA-qualified plans in the future"

Seems provocative, but is there any "there, there?"

Maybe, but it's not that simple:

"HHS stated that HSA eligibility was not a meaningful distinction for health plans because consumers can determine whether a plan is HSA-qualified by examining a plan’s cost-sharing amounts. So, it will not require HSA-qualified plans to be designated as such."

The term of art which used to denote HSA-compliant plans is "High Deductible Health Plan" (HDHP). With Bronze level ObamaPlans touting $6,000+ individual deductibles, though, this seems a distinction without a difference: why is this $6000 deductible plan HSA-compliant, and that one not? Seems silly.

So where's the beef?

The linked article points to two requirements that (allegedly) sound the HSA death-knell:
"1) Plans must apply specific deductibles and out-of-pocket limits that are outside the requirements for HSA-qualified plans.

2) Plans must cover services below the deductible that are not considered “preventive care.”

Let's unpack these, shall we?

As to the first, the article anticipates that no 2017 Gold, Silver or Bronze plan designs will likely meet HSA plan requirements. But it admits that these requirements aren't even determined yet. Funny, but my Ouija board lacks dollar signs.

The article then goes on to note that the 2017 Bronze level deductible will be $6,650, while the max allowable HSA deductible is $100 less.

Um, so? Easy fix: adjust the HSA plan requirements. If they can make up additional sub-deductible requirements out of whole cloth, seems like there's no obstacle to adjusting the HSA requirements.

As to the second issue: in order to make ObamaPlans more "attractive to consumers" (yeah, I couldn't keep a straight face typing that, either), HHS is throwing another boatload of "freebies" into the first dollar coverage area. These include non-preventive benefits that are specifically prohibited in HSA plans.

Now that does seem pretty dispositive: they've basically set up a can't-win scenario for HSA's. Are there fixes for this? Sure: just exempt HSA plans from the requirement.

Will they do this?

I have to go with the article's author on this: No.

Someone asked me recently why the government would seek to phase out HSA plans, and I think it's a very simple calculus:

First, money inside the cash account is tax deductible and tax advantaged, which means fewer dollars for Uncle Sugar. Can't have that, don'tcha know.

And I think there's a second, more insidious reason: folks attracted to HSA's tend to be those with good planning and financial acumen, who want more control over their health, and fewer dollars to the government and its lackeys insurance companies.

Want proof of the latter?

Then ask yourself this: if the
Bureauweenies in DC© really wanted to enable us to be more self-regulating, why not make all plans HSA-compliant? That is, anyone with any plan can set up and contribute to an HSA.

Fat chance, I know.

[Hat Tip: Ace of Spades]