GOP’s bid to expand high-deductible health plans splits Democrats


A bipartisan push in Congress to make high-deductible health insurance plans more attractive to Americans has sparked a debate among Democrats over the merits and risks of such plans.

What are high-deductible health plans?

High-deductible health plans (HDHPs) are a type of health insurance that offer low premiums and tax breaks, but require patients to pay more out of pocket before their benefits kick in. HDHPs are often paired with health savings accounts (HSAs), which allow people to save money for medical expenses and enjoy tax advantages.

GOP’s bid to expand high-deductible health plans splits Democrats
GOP’s bid to expand high-deductible health plans splits Democrats

According to the IRS, in 2023, an HDHP is defined as a plan with a deductible of at least $1,400 for an individual or $2,800 for a family, and an out-of-pocket maximum of $7,050 for an individual or $14,100 for a family. These amounts are adjusted annually for inflation.

What is the GOP’s proposal?

A group of House Republicans, led by Rep. Brad Wenstrup (R-Ohio), has introduced a bill that would allow HDHPs to cover more services before patients reach their deductibles. The bill, called the Chronic Disease Management Act of 2023, would permit HDHPs to cover chronic care services such as diabetes management, blood pressure monitoring, asthma inhalers, and mental health counseling.

The bill has gained bipartisan support from some Democrats, such as Rep. Earl Blumenauer (D-Ore.), who see it as a way to make health care more affordable and accessible for people with chronic conditions. The bill was approved by the Ways and Means Committee in June on a strong bipartisan vote.

Another bill, called the Increasing Access to Quality Telehealth Act of 2023, would allow HDHPs to cover telehealth services before patients meet their deductibles. The bill was sponsored by two Republicans, Reps. Michelle Steel (R-Calif.) and Adrian Smith (R-Neb.), and two Democrats, Reps. Susie Lee (D-Nev.) and Brad Schneider (D-Ill.). The bill also passed the Ways and Means Committee in June.

The proponents of these bills argue that they would encourage more people to enroll in HDHPs and HSAs, which they believe would lower health care costs by promoting consumer choice and market competition. They also claim that these bills would improve health outcomes by removing barriers to preventive and primary care.

What are the criticisms of the GOP’s proposal?

However, not all Democrats are on board with the GOP’s proposal. Some Democrats, such as Rep. Lloyd Doggett (D-Texas), the ranking member of the Ways and Means Health Subcommittee, oppose the bills on the grounds that they would mainly benefit the wealthy and undermine the Affordable Care Act (ACA).

Doggett argues that HDHPs and HSAs are regressive tax shelters that favor high-income earners who can afford to save money and pay high deductibles. He also contends that HDHPs offer inadequate coverage that exposes people to financial and medical risks if they face unexpected or serious health issues.

Doggett also criticizes the bills for expanding the definition of preventive care, which he says would weaken the ACA’s requirement that insurers cover essential health benefits without cost-sharing. He fears that this would create a loophole for insurers to offer skimpier plans that do not meet the ACA’s standards.

What are the implications of the GOP’s proposal?

The GOP’s proposal to expand HDHPs has implications for the future of health care policy in the US. It reflects the new state of play on health care for Republicans, who have shifted away from trying to repeal the ACA but still seek to promote market-based solutions. It also reveals a split among Democrats, who have different views on how to improve access and affordability of health care.

The proposal also raises questions about the effectiveness and equity of HDHPs as a tool to reduce health care spending and improve health outcomes. While some studies have found that HDHPs can lower costs by reducing unnecessary or low-value care, other studies have shown that HDHPs can also deter people from seeking needed or high-value care, especially among low-income or chronically ill populations.

Moreover, some experts have argued that HDHPs do not address the underlying drivers of high health care costs in the US, such as administrative inefficiencies, provider consolidation, price variation, and lack of transparency. They suggest that more systemic reforms are needed to improve quality, value, and equity in health care delivery.


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