Senator Bill Cassidy, a Republican from Louisiana, has proposed redirecting government funds to health savings accounts (HSAs) for Americans instead of continuing subsidies for insurance premiums under the Affordable Care Act (ACA). This proposal comes amid a broader Republican reluctance to extend existing government subsidies that assist with medical bills and insurance costs.

High-deductible health plans (HDHPs), which require patients to pay significant out-of-pocket costs before insurance coverage begins, have gained traction over the past two decades. These plans were initially promoted as a means to empower patients and control healthcare costs. However, evidence suggests that this model has not effectively led to lower healthcare expenses or improved patient outcomes. Currently, the average deductible for job-based coverage is approximately $1,700, a significant increase from around $300 in 2006.

Despite the intention behind HSAs, many individuals, like Sarah Monroe, have found themselves overwhelmed by medical debt, even while insured. Monroe, who faced a serious health condition during her pregnancy, accumulated over $13,000 in medical debt due to her high-deductible plan. The expectation that patients will shop for lower-cost care is often impractical, particularly in complex medical situations where timely treatment is critical.

Research indicates that a substantial portion of healthcare spending is not amenable to price comparison, as many services arise from emergencies or involve long-term treatment plans. A study presented at the American Society of Clinical Oncology found that cancer patients with high-deductible insurance were more likely to experience adverse outcomes compared to those without such coverage.

The financial strain of high-deductible plans has led many families to make significant sacrifices, including downsizing their living situations and depleting savings. Critics of the current healthcare funding proposals argue that the reliance on high-deductible plans and HSAs may further entrench inequities in access to necessary medical care, leaving millions vulnerable to financial hardship due to medical expenses.