Health Savings Accounts Come Under Fire

Proponents of HSAs argued that because the GAO had relied largely on data from the second year of the program, the report might not accurately reflect current HSA usage. They say HSAs make health care more accessible by allowing individuals and employers to buy into plans with lower premiums and would discourage people from buying unnecessary medical services.

But witnesses testified that the invisible hand didn't appropriately guide health care decisions. People who forgo preventative care because of high deductibles may ultimately consume more health care if they come down with preventable diseases.

Patients are often forced to make health care decisions when they are sick, stressed, or at times cognitively impaired.

"It's hard to expect people in those situations to respond appropriately to price signals," said Michael Chernew, Professor of Health Care Policy at Harvard Medical School. Evidence suggests that, when charged more for health care, patients cut back on appropriate treatment as much as they cut back on inappropriate treatments, he added.

Critics also voiced concern that as healthy individuals eschewed HSAs for more comprehensive coverage, premiums for comprehensive coverage would rise become less affordable to those most in need of insurance.

"The higher-cost insured population remaining in comprehensive coverage will tend to see their premiums rise as the healthy peel off into high-deductible/HSA plans," said Linda J. Blumberg, Ph.D., Principal Research Associate at the Urban Institute.

Without changes to the plan, "This dynamic will make coverage less affordable for those with the greatest medical needs," she said.