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Health Savings Accounts and High-Deductible Health Insurance Plans : Implications for Those with High Medical Costs, Low Incomes, and the Uninsured

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Publication Date: February 2009

Publisher(s): Tax Policy Center

Author(s): Linda J. Blumberg; Lisa Clemans-Cope

Special Collection: John D. and Catherine T. MacArthur Foundation

Topic: Health (Health care financing)

Keywords: Tax Policy; Taxes and Social Programs; Health and Health Care; Health Insurance

Type: Report


Health Savings Accounts (HSAs) and high-deductible health plans are prominently featured in many discussions of health reform. The hope of supporters is that they will make individuals more prudent purchasers of medical care. However, the tax structure and incentives built into HSAs make them most attractive to the high-income and the healthy, populations already advantaged by the current system. HSA/high deductible plans shift more of the health financing burden onto those using significant amounts of care, with negative ramifications for the low-income and high-need. Nor is it clear that cost-containment, higher value shopping, or reductions in the uninsured will follow.