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Mitt’s Plan to Destroy Health Savings Accounts

Tonight I went to Romney’s website for the first time to see if he add any plan on taxes. (In short..No. He plans to “maintain” the current tax rates on personal and capital gains and bring our corporate rate down to europe’s rate). Anyway, I came across this little nugget:

“he (Romney) believes that we should permit HSA funds to be used to pay for health insurance premiums”

Now, many of you may be thinking that sounds like a good idea. However, the purpose of health savings accounts is not to be a give away, but to reduce health care costs.

For those unfamilar, HSAs allow workers to put some of their own money, tax free, into an account that can only be used for health care services/medications or retirement. These accounts enable people, if they choose, to purchase the much cheaper high deductible insurance plans. High deductible plans require more money out of consumer’s pockets, but the health savings accounts are so efficient that they allow people to save enough money to cover these higher out of pocket expenses.

To illustrate, my employer gives us the option of a high deductible plan with a maximum out of pocket expense of $3000. BUT the premiums are $360 cheaper per month for my family coverage. Wait?? $360 per month x 12 months is more than $3000. So we are guaranteed to save money AND if we do not need to go the doctor’s office very often we save a lot of money. Why is the premium for high deductible so cheap it actually pays for itself???

Well, it turns out that high deductible plans made possible by Health savings accounts reduce health costs in several ways*:

1) When people pay for a procedure out of their own HSA, they have an incentive not to waste their money to get procedures they really do not need.

2) It encourages people to shop for better deals (friend found colonoscopy for $500 instead of $3500). That is, it creates competition among providers.

3) It reduces paperwork. No approvals to get. No medical claims to file, etc.

So how would Mitt’s plan destroy HSAs and drive up health insurance costs? HSAs only work to reduce medical costs because it makes high deductible plans more attractive since the HSA money can only be used for out of pocket expenses. If people could use their HSAs to buy traditional insurance, then employers will have less incentive to offer high deductible plans. The HSA benefits will be lost and health care costs will rise at an even faster pace. The economics of this are simple: anytime a person receives a service but does not pay the bill (or even know how much the bill is for!), there is less incentive to watch costs and so those costs go up.

Romney should know this and it shows a lack of understanding about how market forces work. Perhaps that is why Romney has been “surprised” by the dramatic, catastrophic cost over-runs under RomneyCare. One simple story illustrates this lack of understanding in RomneyCare. Emergency room treatments are very expensive and so Romney believed that RomneyCare would reduce the number of emergency room treatments since people could use their state health insurance plan to see a regular doctor. But what happened instead is that people— now freed from having to pay for emergency treatment under the state’s laws –made many more trips to the emergency room.

How can we rally against ObamaCare if our nominee supported a big government takeover of health care in his state? His solution has created massive budget problems for the state.

Contrary to his claims that the Federal Government would leave decisions to the state his website shows he plans for Washington to provide funds to states for the uninsured: “We can empower states to expand health care access to low-income Americans by block-granting funds for Medicaid and the uninsured” Can he promise us that there will be no regulations or strings attached to this funding? Romney is not a conservative and his plans will drive up health care costs.

*Additionally, unlike the points above which are known characteristics of high deductible/health savings account plans, there may even be a long term benefit. When people buy things out of their own pocket, they tend to be stingy. They evaluate alternatives, they consider how desireable the service is to their happiness. Providers (Doctors) wanting to attract more patients therefore seek ways to lower the price to attract more customers. They seek more efficient, lower cost methods and equipment. Equipment manufacturers respond by providing these more efficient equipment allowing doctors to offer lower costs to patients. This has been shown to be true in the two medical services where insurance is not used—cosmetic and lasek surgeries. The costs of these procedures over the last decade have actually decreased! While traditional medical costs have risen at double digit rates.

COMMENTS

  • dcarter888

    All of you ABR should get the facts prior to doing hit pieces

  • lineholder

    in evaluating the position Romney has stated pertaining to health care that is being presented in the video below. He says that he would “repeal the bad and keep the good” in Obamacare, which to my point of view means that he isn’t likely to pursue complete repeal of the legislation.

    I believe that there are some good things included in O-care. But having the government dictate it and/or manage it just isn’t the best way to go about providing high quality care in the most cost-productive manner

    Re: your last paragraph above, how do you see payment capitation for providers fitting into the context of free-market mechanisms that might reduce cost of care?

    • snowshooze

      And you know what is funny?
      Nobody ever points out that insurance is not health care.
      It is insurance. All the insurance men on the face of the earth could not get you any closer to you doctor than you already are. Or save you any money by putting an entire corporate structure between you and your doctor.
      Somehow, someone thought a middleman was a cost cutting feature.

      • lineholder

        into believing that these types of systems are effective. They aren’t. Not even close. With the most significant point being exactly what you’ve stated, i.e. provision of health insurance and provision of health care are not the same thing. They are completely and totally distinct.

        As to the middleman….when the middleman is gov’t, they become bloated and greedy for themselves, draining resources out of the entire system.

        BTW, this video was recorded in 2012, right after O-care was passed.

        • lineholder

          -

        • snowshooze

          State Farm?
          hey, I will go to a veterinarian. They are the last of the real General Practitioners.. in my case…my Wife.

          • lineholder

            broader spectrum of species than MDs know, snowshooze, that’s for certain. Totally different usage of meds, too. Very intelligent people.

            It’s ludicrous isn’t it, the idea of walking into an insurance agency to receive health care? Just as ludicrous as walking into a doctor’s office and finding an insurance agent there but no doctor. And that’s not far off from reality when it comes to how well this type of system succeeds.

    • quill67

      There is so many things wrong with Romney’s view here:

      1) Insurance does not work if you allow people to buy it who have pre-existing conditions. You can’t buy home owners insurance AFTER your house burns down. So the only way this works is if everyone buys into the pool and by his own admission 3% of people do not.
      2) The state exchanges. Do these exchanges not require some specific coverage? Of course they do. and who decides? The State. So the government decides what insurance you can buy…great.
      3) The 10th amendment guarantees rights not expressly given to the Feds are reserved to the states OR THE PEOPLE. (Politicians forget that one)
      4) He did it without raising taxes! Wow. In 2009, the state was already spending nearly $600 million more than it did previously. And the tax increases that followed Romney had NOTHING to do with this new benefit??? Really?
      5) And the point you made–he only said repeal the bad and keep the good.

  • lineholder

    I wasn’t talking about capitation pertaining to health insurance rates. What I meant was capitation pertaining to payment for provider services. I didn’t specify that difference.

    You made reference in your last paragraph to providers seeking to attract more customers and the influence of free-market principles on the prices they offer to consumers. And you provided two examples of how prices have decreased in sectors of health care that are not covered by third-party payers, i.e. lasek surgeries and cosmetic surgeries.

    Third-party payers say that they use capped rates to keep prices down, correct? And if comparison to the increase in prices that we were seeing in the past under a fee-for-service, that’s true…capped rates do keep price rates down.

    But doesn’t capitation also interfere with true market principles of supply and demand in a way that keeps prices UP? If a provider knows that they can obtain a specific price (even if it’s a capped price) from a third-party payer, what motivation do they have to make any efforts to reduce their prices below that capitated payment rate? What reason do they have to compete on this?

    • lineholder

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  • quill67

    While medical providers may have some motivation to reduce costs to earn greater profits, this is a lot different than not making the “sale” at all. Not making the sale dramatically harms profits which happens if the price is consider too high by a consumer in an unregulated market. This also has upstream effects as well. Suppliers do not feel as pressured to provide technologies that drive down the cost.

    By the way, this is the same problem faced with auto emissions–once an automaker reaches the required level they get no benefit from reducing emissions beyond that point.

  • quill67

    Please see my new Diary entry using quotes from New England Journal of Medicine and Cato institute showing how RomneyCare added 18% more administrators and yet no significant increase in doctors/nurses.

    I hope you agree this is EXPLOSIVE stuff.

  • mrhsa

    You are giving credit to Mr. Romney for an idea that is not his own. Several bills pending in the current and past Congresses would allow individuals to use HSA funds to pay for their health insurance premiums. Current law already allows individuals to pay COBRA premiums with HSA funds, and any health insurance premiums if the individual is receiving federal or state unemployment benefits.

    The reason for allowing individuals to use HSA funds tax-free to pay for their health insurance premiums generally is that individuals who purchase their own health insurance get no tax deduction unless their combined medical expenses (including insurance premiums and out-of-pocket expenses) exceed 7.5% of their adjusted gross income and they itemize their deductions. By allowing them to use HSA funds to pay their premiums, these individuals can get something closer to the tax advantages provided to employees who get their health insurance tax-free through their jobs. In addition, if the individual doesn’t purchase an HSA-qualified plan, they wouldn’t be eligible to continue to put more money in their HSA, so it really only makes sense for them to take advantage of this provision if they have such a plan.

    I believe you are incorrectly giving Mr. Romney credit (or blame) for this idea. Second, I think you are missing the point about the inequity in our tax system today.

  • http://edgeinducedcohesion.wordpress.com nathanalbright

    That would be a very good appeal of an HSA for someone to use. Would there be similar benefits for small businesses and entrepreneurs looking to use them to make sure their health costs do not suffer because they cannot take advantage of the law of large numbers that larger firms use to lower health insurance costs?

  • quill67

    It will all be privately owned by individuals. Taiwan for example requires workers put 6%-8% of their salary into an HSA (We could achieve this without mandates but by tax incentives) The only insurance they have is for catastrophic because who needs to have insurance if you are putting so much money into your own health savings account.

    So virtually every transaction is done by “cash” through their HSA. Think about how much this saves their economy. No insurance claims to file! Unlike the liberals “single payer system” that still requires paperwork, HSAs require virtually no paperwork because it is your money. And while fraud is rampant in government health programs (Medicare is estimated to suffer from $60 B per year. That is more that a $1000 per recipient), High deductible/ HSA plans have much less fraud because when a person does make a claim it is for a major health issue performed at a hospital that have computerized systems that reduce fraud. Smaller transactions are where it is easier for fraud to occur because the volume and small transactions make the investigaton costs very high.
    Just a note: Taiwan’s system involves the government providing the catastrophic insurance, but this could easily be provided by private sector.

  • dcarter888

    All of you ABR should get the facts prior to doing hit pieces

  • californiagold

    The financial costs involved with having the states pick up the entire cost of medicaid would be, and are, enormous.

    What really needs to be done to reform the system is to create competition. Unfortunately, Obamacare reduces competition…and none of the current republican candidates are offering a solution to replace ObamaCare.

  • quill67

    The point of my post was to point out that Romney has no understanding of how HSA’s work to lower costs. HSAs are designed to put people back in charge of their health care spending instead of some third party (insurance companies or governmnet). Allowing people to buy health insurance with HSA money puts us right back with a third party payer that has driven up health care costs. But I guess it is understandable that Romney doesn’t understand this given that he put GOVERNMENT in charge of all health care in Mass. Now, he will rightly claim that his bill has been perverted but that’s why conservatives understand that government should be limited. Governments always pervert any power they are given.

    By the way, I do not oppose Block granting Medicaid back to the states–in fact I think that is a good idea. ButRomney not only specifies the poor (Medicaid) but also the uninsured (who may or may not be unable to pay for insurance) So ust like Mass. plan got “perverted” block granting money to states to provide for the uninsured will surely be changed over time to a MANDATE that states provide health insurance. Government run health care at the state level is little better than at the Federal level because Washington will eventually simply mandate how the states spend this money.

  • mobius2702

    “If people could use their HSAs to buy traditional insurance, then employers will have less incentive to offer high deductible plans.”

    Where does it say that people would be allowed to use HSA funds to purchase traditional insurance?

    Only very specific insurance policies work with an HSA. Allowing people to use HSA (pre-tax) funds to pay the premiums for an HSA eligible policy would likely drive *more* people to those high deductible HSA eligible plans.

    It is my understanding that if you are over 65 or unemployed, you can already use HSA funds to maintain your policy.

    This looks to me to be a wonderful idea. Employer-provided (or group plan) insurance policies are already paid for with pre-tax dollars or as an expense to the business (benefits). There is no reason that those who are self-employed or providing their own insurance should have to pay premiums in after-tax dollars. This HSA proposal is a step in that direction.

  • quill67

    and not worse. I believe in markets. Third party payers systems whether they are government or private result in very bad outcomes and rising costs.

    Allowing people to use their HSAs to buy traditonal insurance will cause them not to have as much money to use to pay for their medical expenses out of their own pocket so more claims forms have to be filled out, more people not paying attention to the true cost of medical care, and medical providers not worrying about how much it costs to provide treatment. The result is higher costs, more people who cannot afford health insurance and more wasted human effort filling out useless paperwork. This creates more pressure for the government to step in to pay these costs.

    If you have some influence with Romney, you might explain to him that while his idea sounds good, it is actually the exact opposite direction we need to go.

    Respectfully,

    Quill67

  • quill67

    “Re: your last paragraph above, how do you see payment capitation for providers fitting into the context of free-market mechanisms that might reduce cost of care?”

    Payment caps by government are just a fancy way of describing price controls.( A good read on this is Four Thousand Years of Price Control ) Price controls always sound good. Prices of medical services are only so high because of the third payer problem (when someone else pays the bill we don’t worry about the price)

    Payment caps by private insurance companies are an ordinary negotiation process. If the cap is too low, patients have to pay more money out of pocket reducing the desirability of that insurance plan. Think about home insurance. Insurers might love to not pay fair claims but if they did future buyers would not buy their insurance so reputation matters. One legitimate role for government would be to help bring information about health insurers behavior to the potential buyer’s attention and to encourage competition in the market by reducing unneeded regulations that hinder competition.

  • JSobieski

    gets one big third party out of the equation.

    If individuals start making their own choices and start paying for their own insurance, people will look at LPHD plans because they will be spending their own money.

    In the same way that Obamacare will lead to government option and single payor eventually, the Romney idea will ultimately lead to what you want—it just takes longer to get there.

  • acat

    is which direction Waffles Romney is pointing …

    From what he’s said, he’s for repealing Obamacare, he’s for issuing waivers but not repealing, and he’s for tinkering with it to make it more streamlined.

    I’m in agreement that de-coupling insurance from employment is a Good Idea – should’ve been driven that way by tax policy post-WWII – but .. I have the impression that Romney has a direction in mind but isn’t telling anyone what it is …

    Mew

  • quill67

    But nothing I’ve read indicates that Romney said that the HSAs could only be used to buy individual insurance. What is to keep someone to use their HSA to buy employer provided insurance? Again, we want people to buy medical care out of their own pocket rather than through an insurance company (or gov’t) Doctor (Pediatrician) friend of mine says that for his network of offices that half of his expenses are to pay for the filing of insurance claims.

    Ideally, I would like people to be able to save up at least $20K during their 20s and 30s so that they can buy high deductible insurance and save lots of money and have more control over what doctor to see. For example, most people you and I know probably have a $1000 deductible on their auto insurance because in a matter of a couple years it pays for itself. And yet, many poorer people go for a low deductible because to them coming up with a $1000 would be a big burden if something were to happen.

    I want to enable people to be able to be more independent and HSAs do that but buying traditional insurance does not.

  • JSobieski

    i.e. that the employer pays the premium or that the premium is paid through the employer.

    More importantly, you miss the point about HSAs.

    For people with full service plans, their premiums are extremely expensive. Most businesses would rather just give the cash to the employee, and let them deal with their own lives (in the same way that employers have no role in my purchase of a house, a car, etc).

    In contrast, a LPHD plan is very inexpensive. My plan costs $150/month for example.

    So for people with robust coverage today, they can pocket quite a bit of money if they get close to what the employer used to pay for insurance and manage it themselves with an HSA.

    Employer saves 10% instead of constant increases.
    Employees do a bit more shopping around when they can.
    Services are used more efficiently.
    A market is created, and markets are the best way to address cost and supply issues.

  • JSobieski

    Romney is simply allowing people to use their HSA accounts to achieve some of the tax advantages that employers currently benefit from. I agree that this is kind of like using a laptop as a paperweight.

    However, I don’t see it as harmful—only the most efficient use of the tool.

    Buying traditional insurance outside of the employment relationship does make people more independent. It also makes them more likely to go for lower premiums. Most people want more control over their own lives.

  • JSobieski

    The waiver stuff is just something he can do on day one without Congress.

    If there is evidence to the contrary, I would like to hear it. However, that is my impression.

  • acat

    About this time last year, he was still talking about “fixing” Obamacare.

    There’s video, I’m too lazy to run it down but IIRC Ace of Spades ace.mu.nu had it up within the last couple days.

    That’s why I don’t know what direction he’s going to go in .. he’s been caught on camera pointed in so many different ones…

    Mew

  • JSobieski

    To defend Romneycare is to see the issue differently than a liberty-based conservative point of view.

    On the other hand, one can be positively surprised. I had Michigan’s governor pegged as a Romney squish—but he has been quite good.

  • http://www.examiner.com/x-1597-Charlotte-Law--Politics-Examiner Mike gamecock DeVine

    due to his refusal to admit the error of RomneyCare in practice!

  • quill67

    BTW, I like your quote “Requiring Someone to pay their medical bills is not an individual mandate!” The difference in opinion here is that I feel it is essential to stop the run away cost of medical care–while you seem to focus on the number of people without insurance. I feel that if we can bring down the cost, more people will buy it. You seem to feel that the government helping fund insurance premiums is the way to go. But I think that by subsidizing more of the same that health costs will continue to spiral upward because whether the employer buys it for you or you buy it for yourself, third payer systems drive up costs. Therefore, I do not think we should subsize this type of system but rather get people to pay more of their own medical expenses directly.

    Have I stated your view correctly?

  • JSobieski

    I simply make it a point to be at least somewhat complimentary to any directional movement that is positive.

    I totally agree with you that Mitt’s comment on HSAs isn’t really what they are for.

    However:
    (1) Mitt is talking about HSAs
    (2) He is talking about expanding them
    (3) He is talking about decoupling insurance from employers

    From current medicare to medicare with a private option is an improvement. I would prefer a voucher to government approved plan. However, it is a move in the right direction.

    Anything that expands HSAs is a move in the right direction.

    Anything that decouples employers from insurance is a a move in the right direction.

    My point is this:
    Government and employers already subsidize the health care decisions of many people

    This happens without any individual accountability of the patient

    Anything that makes individuals more accountable/empowered is a good thing.

    I don’t attack people for moving more slowly than what I would prefer. I think this latest development with Ryan and the D Senator from Oregon is a very good thing, even though it means more watered down reform.

  • Kyle-MI

    The fundamental problem with cost containment is the third party paying system, whether that third party is the government or business. Right now we are in the worst of both because the government has set up the tax system to hugely favor businesses playing the third party.

    We need to decouple health insurance from the business place. We could try to change the accounting, eliminate the tax break for the businesses, and just let them pay their employees with money instead of the health care benefit.

    However, many in the public think that they are getting their business provided health care for free. They are under the mistaken impression that the government is forcing business to take care of their employees (at not cost to the employee). What they don’t realize is that business factors health care into the cost of hiring that employee. Health care is part of the salary although it is hidden from employees. In other words, if business did not have to provide health care, they would eventually increase the salary because they have already factored it into the hiring.

    Because of this misconception decoupling health care insurance from business is extremely politically problematic. This is where HSA’s come in. IMO, they would be a step in the decoupling and making this politically feasible. HSA’s keep the tax advantage and the appearance that businesses are supplying their employees, but they shift the responsibility and the freedom to the employee. The employee gets to choose which insurance company to go with. Employee can then way the balance between features and cost and come up with the best individual solution instead of what is best for the company or for the group.

    Hopefully, with this freedom, the employee can keep their insurance when they switch jobs. It would be a matter of paying from a different account instead of having to change health insurance companies.

  • acat

    have a similar historical proof?

    Mew

  • JSobieski

    HSA accounts have opened up possibilities

    Limited school vouchers and charter schools have opened up some possibilities.

    The transition of the private sector from defined benefit to defined contribution has done a lot too.

    I think creaping capitalism can work. It appeals to be working in Indiana, where government workers and Medicaid recipients have private accounts and the change is popular.

    I think there is no question that a D Senator has signed up for a Ryan compromise plan at least in part because of the changes above have made the changes more politically acceptable.

  • JSobieski

    This person should be your primary target:

    http://videocafe.crooksandliars.com/heather/michele-bachmann-backs-away-ryans-medicare

    WALLACE: What do you tell people nearing retirement who say I can?t afford to pay more of my own healthcare costs out of pocket? Which is what the Ryan and Republican Study Committee plans would do.

    BACHMANN: And I understand that. I put an asterisks on my support, I put a blog posting up that said just as much. That is my area of concern, I support this bill with that proviso. ? One position that I?m concerned about shifting the cost burden to senior citizens. Seniors are saying, look, I?m not in a positon to be able to handle that. I also share that real fear, that?s why I put that asterisks out there. [...]

    WALLACE: So you?re not wedded to the idea of a voucher program for Medicare?

    BACHMANN: I?m wedded to the idea of efficiencies and cost cuttings and savings in healthcare, but how we get there is open to discussion.

    “efficiencies and cost cuttings and savings in healthcare, but how we get there is open to discussion” is what one would expect Romney to say, not a Tea Party Caucus leader with a “titianium” spine

  • quill67

    Creeping capitalism works! I focus on healthcare for one reason. Did you know that if we could keep the cost per recipient the same for Medicare (even with population growth) that we would run a surplus in 10 years!

    Change of topic since you mentioned vouchers. You said “limited voucher” idea but I think I know your concern. There are some very good public school systems. What would you think of a system (as a compromise) where a large voucher would be sent to each parent but school districts could tax away those vouchers.

    Parents in areas with good public schools would gladly accept thes vouchers being taken by the district. For parents in areas with poor schools, if the government tried to take the vouchers they would 1) either be voted out of office or 2) parents not willing to accept it could move to a district that did not take the funds. (Remember this is a compromise. I would prefer a straight voucher system)

  • JSobieski

    no jurisdiction I am aware of has a full fledge voucher program that is equivalent to college financial aid. The various systems I am aware of all seem quite limited—but I support them regardless.

    Your idea sounds interesting—although it may be too complicated for an effective political sale.

  • acat

    While he may try to circumnavigate each issue, at least he’s willing to give progress reports. “Today, I sailed along the east side of anti-abortion…”

    Michele appears to rely on describing one facet of the issue most apparent to the Tea Partiers and claim she will climb it. Perhaps she needs a running start?

    Mew

  • JSobieski

    one step below Rick Santorum.

    I think Bachmann is in some ways, an Obama of the right. No real record, but says the right things.

  • acat

    (the other being outsider-and-libertarian-conservative Sarah Palin… seriously, check her record!)

    The proposal was, IIRC, to transition health care to a benefit, with an increased personal deduction to cover it.

    Seemed like another good idea that, with a more compelling candidate, we could have gotten done.

    Mew

  • snowshooze

    And I would rather spend every cent I have and accrue assets rather than save it only to watch it’s value evaporate.
    If you have any money… spend it now because next week… it will be worthless.

  • snowshooze

    BUT… still a big improvement over Obama.

  • JSobieski

    The purpose of an HSA is not to build equity—it is to replace a non-account/hidden invoice.

    P.S. If money has no value to you, I would be more than happy to take if off your hands.

  • acat

    the belief that high inflation and possibly hyperinflation are headed our way is not uncommon .. and is possibly true. I know prices have been creeping up at the grocery store, although I haven’t checked the Big Mac index* in a while.

    That said, the underlying point of an HSA isn’t that it accumulates dollars, it’s instead to break the mental wall between healthcare costs and healthcare recipients – people get a sense of skin in the game and will act with additional fiscal responsibility.

    This cat is wondering just how long it’ll take for inflation to “correct” the real estate market….

    Mew

  • snowshooze

    I save nothing. i spend every cent My money is tied up in tools, equipment and materials. Solid assets. I advise strongly that you stay out of dollars. Pick any asset. Dollars don’t even make good toilet paper.

  • JSobieski

    nt