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Invited Commentary
Health Policy
July 17, 2020

High-Deductible Health Plans and Health Savings Accounts: A Match Made in Heaven but Not for This Irrational World

Author Affiliations
  • 1Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
  • 2Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
  • 3Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
  • 4Duke Clinical Research Institute, Durham, North Carolina
JAMA Netw Open. 2020;3(7):e2011000. doi:10.1001/jamanetworkopen.2020.11000

In JAMA Network Open, a study by Kullgren and colleagues1 fills a gap in our understanding of health savings account (HSA) use in the context of high-deductible health plans (HDHPs). Proponents for HDHPs argue that these plans can help bend the cost curve in the insured population because premiums are lower than in health plans with lower cost-sharing. In addition, it is argued that HDHP enrollees will be more price-sensitive consumers of health care because they must pay for the full cost of qualified health care services until they reach the deductible limit (a mean deductible of $5316 in 2020 Health Insurance Exchange plans).2 Enrollees in HDHPs are offered HSAs to have the option of contributing pretax income to an account specifically used to cover the high cost-sharing of HDHPs, and HSA balances can accrue over time because they are not subject to the “use it or lose it” provision of flexible spending accounts. High-deductible health plans have the potential to realize these goals if enrollees participate in an HSA (when offered it) and make contributions equal to their expected out-of-pocket spending.

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