Health care’s future: Turning patients into savers, shoppers

The U.S. government may soon lean on someone new to help lower health care costs: you.

The idea is that when your money is on the line – and not the insurance company’s – you’ll look for the best value and do your part to curb national health care spending.

The Affordable Care Act’s fate is up in the air as President Donald Trump and Congress weigh plans to overhaul the law. While much remains unknown, Republicans indicated last week that they will encourage wider use of insurance that comes with a health savings account aimed at pushing patients to save and shop for care.

This coverage has been around for years and is becoming more common in plans offered through employers. It comes with a high deductible, which means most insurance doesn’t start until patients first spend up to a limit that can top $10,000 for family coverage.

To ease that pain, the health savings account, or HSA, lets customers set aside money before taxes, and some offer the chance to invest the balance in mutual funds like a retirement account.

Patients who have used these accounts for years say they save money, and the coverage changes how they approach care. But these plans also may push patients to skip care or quickly pile up debt. The shopping they encourage also is limited.

Jenel Stelton-Holtmeier wound up several thousand dollars in debt a few years ago after heart attack symptoms sent her husband to the hospital. The pain turned out to be sprained ribs. Bills from his care hit the couple before they could put money in an HSA.

“You have to have a mindset of planning for it because you are going to be paying for everything up front until you hit that deductible,” the 41-year-old Boulder, Colorado resident said.

The couple had no chance to shop for a better deal since they had an emergency. Even if they had time, Stelton-Holtmeier doubts they would have made progress.

She found doctors hesitant to provide a price specific to the care she needed when she did try to shop. Plus her insurer didn’t provide tools or directories for comparing cost and quality.

Money set aside in HSAs also grows tax-free and isn’t taxed when used for medical expenses. That triple layer of protection is unique among investment options allowed under federal tax law, according to Jay Savan of the consulting firm Mercer.

Patients can keep their accounts when they change jobs and build their balances over time.

Real estate broker Francisco Nieves-Taranto used his HSA to cover the entire $8,000 bill from the birth of his fifth child last year.

The 48-year-old figures he’s saved more than $6,000 since switching to an HSA plan several years ago due to the tax breaks and lower monthly premiums.

Nieves-Taranto also has become a discerning shopper, favoring cheaper retail clinics over a doctor’s office for routine care. When he reinjured his knee playing basketball, the Windermere, Florida, resident avoided returning to the doctor because of the cost.

Instead he stopped playing and used ice and stretching to give his knee time to heal. He’s now pain-free and figures he saved a few thousand dollars.

Whether people who opt for this coverage under any federal plan will make it pay off like Nieves-Taranto is far from clear.

Patients with low incomes may not benefit from the account’s tax breaks. They also might struggle to keep money in their accounts.

Others might avoid care. The Employee Benefit Research Institute studied a large employer it did not identify that offers the accounts. It found a steeper drop in doctor visits for workers making less than $50,000 compared to those making at least $100,000.