Health Savings Accounts Won’t Fix Big Insurance’s “Money Sucking”

Big Insurance and Wall Street stand to gain most from the GOP’s “new” old idea.

After the longest government shutdown in U.S. history (a showdown triggered almost entirely by Republicans’ refusal to renew the Affordable Care Act’s enhanced premium tax credit) health care affordability is now a top concern for millions of Americans. And the polling reflects that outrage: Voters across the political spectrum blame the GOP for allowing the tax credits to lapse, threatening coverage and spiking premiums for 22 million marketplace enrollees.

Now, with 2026 elections approaching fast, Republicans are scrambling for a health care message and solution. Out of the gate, President Trump blasted insurers on Truth Social as “BIG,” “BAD,” and “money sucking” — and then immediately proposed a policy that would hand many of those same corporations a fresh stream of revenue and a new pocket to pick: Health Savings Accounts, or HSAs.

And Trump is not alone. Many Republicans in Congress have seized on the idea.

HSAs: a dated, 20-year-old idea

HSAs are not new. They were created in 2003 after being signed into law by President George W. Bush and are now one of the oldest and least effective tools in the health-policy toolbox.

The intellectual godfather behind the idea, economist John Goodman, has long been aligned with the “pro-corporate” movement and the “consumer-driven health care” agenda, which is just a euphemism for shifting more costs onto patients through high-deductible plans.

The premise was simple: If Americans had more “skin in the game,” they would shop for care like they shop for shoes or appliances. But that theory has never matched the reality of the U.S. health system or the financial lives of most Americans.

To this day, HSAs must be paired with high-deductible health plans, almost always sold by Big Insurance companies like Cigna, Aetna and UnitedHealthcare. Without an insurance product to attach them to, HSAs are largely useless – unless you’re fairly wealthy to start with. And when paired with those high-deductible plans, they expose families to thousands of dollars in upfront costs before their insurance pays a dime.

Who stands to gain? Big Insurance, Big Banks and Wall Street

Despite their branding, HSAs mainly function as tax shelters for high-income households, not as affordability tools for people struggling with premiums or medical bills.

According to data cited by the Center on Budget and Policy Priorities, people making $1 million or more were the most likely to contribute to HSAs in 2021, while people making under $50,000 accounted for just 4% of contributions. Meanwhile, 82% of ACA marketplace enrollees — the very people hurt by the expiration of premium tax credits — earn less than 300% of the federal poverty level.

HSAs are triple-tax advantaged:

• Contributions reduce taxable income.

• Investment earnings grow tax-free.

• Withdrawals for medical spending aren’t taxed.

That’s great for wealthy households who can afford to sock away thousands. But most Americans can’t. Four in ten U.S. adults are already in some form of medical debt. Very few have spare cash to save for care they can’t afford in the first place.

Below are some of the biggest corporations that would stand to win big from a HSA-style solution to our country’s health care affordability crisis.

• Optum Bank, the largest HSA custodian in the country and a subsidiary of the nation’s largest health care conglomerate, UnitedHealth Group — giving the same company that dominates the insurance, PBM, physician and data markets yet another revenue stream tied directly to consumers’ out-of-pocket costs.

• HealthEquity, Inc., one of the nation’s largest independent HSA administrators, managing tens of billions in customer assets and profiting from fees and investment income tied to rising account balances.

• Fidelity, a major financial services giant and one of the fastest-growing HSA custodians, leveraging its massive investment platform to turn consumer health-care savings into another stream of Wall Street-managed assets.

This comes at a time when public trust in both insurers and financial institutions is near historic lows. Surveys routinely show that health insurers are among the least-trusted industries in America. So are big banks, too.

What’s the latest on the HSA-solution?

According to Politico, House Republicans on the Ways and Means Committee are circulating legislation that mirrors Trump’s demand to send subsidies “directly to the people” via HSAs, rather than through insurance plans. The proposal — introduced by Reps. Kat Cammack and Greg Steube — would allow ACA enrollees to divert their subsidies into HSAs instead of receiving financial assistance that, if it goes according to plan, would lower Americans’ out-of-pocket costs.

Meaning, the bill would convert guaranteed savings (the kind that protects people from sky-high deductibles and cost-sharing) into an HSA deposit that likely wouldn’t even cover a single specialist visit, much less a stay in the hospital, a round of chemo or an expensive but life-saving medication.

Sen. Rick Scott, who oversaw a company that committed the largest Medicare fraud in U.S. history, has eagerly backed Trump’s proposal. On Fox News, he promoted giving people “HSA-style accounts” and letting them “shop across state lines.” None of these ideas are new. They’ve been studied and floated as a larger solution for decades but there is a reason they have never taken on.

They would do nothing to rein in insurers’ predatory behavior, nothing to control hospital prices and nothing to protect families from financially ruinous medical bills.

Big Insurance will continue to win with HSAs

HSAs can help pay for a doctor visit or a routine medication (and condoms at CVS, which by the way, also owns Aetna) — but only if a family or individual has the money to contribute in the first place. HSAs cannot:

• Cover insurance premiums,

• Shield families from five-figure deductibles,

• Protect people diagnosed with cancer or chronic illnesses,

• Address surprise billing, prior authorization abuses or insurer claim denials, or

• Replace tax credits that millions depend on to afford coverage.

HSAs certainly will not force insurers to stop the “money sucking” Trump is now railing against. It will just redirect the money in a different way to the money suckers, and that different way will benefit the wealthy at the expense of the rest of us. If Republicans wanted to take on insurers, they could crack down on their reportedly fraudulent business practices, limit their wasteful bloat on taxpayer-funded programs or confront their increasingly monopolistic grip on the system. But as it stands, HSAs don’t touch Big Insurers’ business practices or bloat. Instead they could hand companies like UnitedHealth Group an even bigger slice of the pie.

Make no mistake, this will be sold relentlessly as a way to help Americans afford health care and penalize the insurance industry, but it will do neither. Do not be confused and misled by the coming propaganda campaign. Unless you’re a millionaire, you can’t afford to be fooled.