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Study Downplays HSAs Effect On Uninsured

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The Commonwealth Fund is publicizing a new analysis that predicts health savings accounts will make health insurance available to only about 1 million of the 45 million Americans who are uninsured.

The Commonwealth Fund, New York, is a health policy think tank that has backed earlier studies and analyses that have been critical of the HSA program.

The new analysis, developed by Sherry Gilead of Columbia University and Dahlia Remler of Baruch College, suggests that HSA tax incentives will have little effect on national uninsured rates, in part because about half of the uninsured owe no federal income taxes and in part because paying out-of-pocket expenses through an HSA program would cut taxes by less than $120 per year for most uninsured Americans who do pay income taxes.

If large numbers of employers who would be continuing to offer health benefits anyway shift to HSA programs, that could hurt low-income and moderate-income workers by increasing their out-of-pocket expenses without doing much to cut their taxes, the researchers predict.

But America’s Health Insurance Plans, Washington, has collected early survey data suggesting that early sales of HSA programs have been strong and that about 30% of the purchasers have been people who previously were uninsured, according to AHIP spokesman Larry Akey.

Although “the market is very young,” AHIP believes the early HSA survey results are very encouraging, Akey says.

He says AHIP wants to see the government try a variety of approaches to expanding access to health coverage.

“We’re not of the frame of mind that there’s any one silver bullet,” Akey says.

The National Association of Health Underwriters, Arlington, Va., a producer group, likes the HSA program, according to John Greene, NAHU’s legislative director for federal affairs.

“Many employers already have high deductibles,” Greene says, noting that the HSA program gives employees at those employers a new vehicle for handling expenses they’ve had to handle all along.

Like AHIP, NAHU would like to see the government try a number of approaches to helping the uninsured. One strategy might to be to increase federal financial support for state programs that insure the health of residents with health problems, Greene says.

But Greene also suggests that interest groups have been exaggerating the size of the uninsured problem. About half of the “45 million uninsured” have very low incomes and already are eligible for Medicaid, he says.


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