There’s so much spin in the press about Bush’s approach to health care the facts are pretty much ignored. So, as a public service, I’ve winnowed through the partisan, the strident, the pedantic and the ideology-driven cacophony surrounding Bush’s State of the Union proposals for health care to get to the facts about HSAs, CDHPs and consumerism in health care, and the viability of the whole mess .
Here’s the real story, complete with facts, citations, and sources.
HSAs as a means to reduce the number of uninsured
– Robert Laszewski – Bob notes that “increasing the tax-deductibility of out-of-pocket expenses for HSA programs …doesn’t do a whole lot for an uninsured person in a zero bracket…the President’s tax cuts increased the number of low income people who do not pay taxes.” And, studies show fewer than one million of the 46 million uninsured are likely to enroll in HSA plans.
HSAs as a way for consumers to fund health care costs and reduce premiums
That presupposes there is cash in the account to pay for services up to the deductible, and that the policy then covers needed care. Fact is, more than half the 3 million HSAs have not been funded at all – not even a cent. Hard to see how they will pay for care with non-existent funds…
Consumer-directed health plans as a means to reduce health care costs.
No, they won’t. And CDHPs may actually increase health care costs; reports indicate similar programs in other areas have had “unintended consequences” – less compliance with preventive medicine as an example.
Portability of health insurance
Bush’s HSAs are portable, but that does not mean the insurance behind them is. Insurers offering HSAs can still require medical underwriting, which eliminates coverage for chronic conditions and/or increases premiums to a level that is unaffordable. So, insurance is not portable at all. And making it portable would require a drastic change to the COBRA laws, or de-coupling private health insurance from employers. Neither is anywhere close to being considered, much less the subject of legislation. However, Bush’s administration is making an attempt to drastically change existing laws governing these matters – like ERISA, state regulatory authority over insurance plans and the like. These are huge undertakings, and the chances of all the required legal changes actually occuring are zilch.
Viability
This gets to the heart of the matter, which is “do voters believe Bush has credibility when it comes to health care“. A USAToday poll indicates the majority do not. According to California HealthLine, a “USA Today/CNN/Gallup poll of 1,066 U.S. adults conducted between Jan. 20 and Jan. 22 found that about 60% of respondents disapprove of how Bush has addressed health care issues, compared with 40% in mid-2002″.
Couple the citizenry’s skepticism with the potentially negative implications for tax revenue from the Bush proposals, and his stated desire to halve the $900 billion deficit by 2010, and the Bush program looks unattainable.
Which is just as well, as it will do nothing to reduce health cost inflation or expand coverage.