Check out Uwe Reinhardt’s post critiquing a Health Affairs paper (he says the paper is based on a single atypical case and has been used by the pro-HSA gang to support their position). I agree with Reinhardt’s conclusions — I’ve been a fan since George Annas played an audio tape of a Reinhardt lecture in a class of his way back when — but please read the whole post. Reinhardt concludes:
Should policymakers want to make the HSA/high-deductible construct considerably less regressive, they could do so by modifying three parameters of that construct.
(1) The maximum out-of-pocket stop loss visited on individuals and families could be made to rise with disposable income (which raises the delicate question whether corporate executives who are paid annually in the millions of dollars should have any health insurance at all).
(2) Instead of making deposits into HSAs tax deductible, any American individual or family, regardless of taxable-income level, could be granted a refundable tax credit of, say, 30 percent.
(3) Chronically ill individuals and families could be granted risk-adjusted subsidies, so that the chronically ill are not forced to bear the entire maximum risk exposure under their health insurance out of their own resources.