Responding to the study showing HSAs end up costing women are $1,000 more per year, Julian writes:
I feel a bit churlish quibbling about this, but wouldn't an equally reasonable frame here be that the more common low-deductible plans amount to a $1,000 cross-subsidy to women?
Well, which more common lower-deductible plans? According to the Kaiser Employer Health Benefits Survey, 63% of individuals in HSAs are in HSAs with deductibles of over $2,000. And 71% of families in HSAs have deductibles over $3,000. So I'm not sure who's in all these $1,000 HSAs, but they're certainly not getting picked up in the literature. Worse, these are employer-sponsored HSAs, and we'd expect those purchased on the individual market to have higher, not lower, deductibles.
So take the average individual HSA, which has a deductible of $2,011. For a male, out of pocket expenses will average $500. For a female, they'll average $1,200. And women make less anyway. Now, one of two things can happen here. Women can continue using health care at their current rate and pay more, or the expected cost effects will occur and women will begin using less health care. Given that the $1,200 number is for routine care -- mammograms and the like -- we don't want to disincentivize their routine, preventive care. So what we're really doing is simply making them pay more for health care because...they're women. And because we haven't thought this through very much.
We can, however, exempt some of these costs from the deductible. Some HSAs currently do that for pregnancy-related care, mammograms, cervical cancer screenings, etc. We could expand that across a range of preventative, routine, or cost-effective services and erase the gap. But given that HSAs are not generally $1,000 deductible plans, the study's conclusion stands: Women are getting screwed.
Update: Julian IMs to clarify that by "low-deductible plans," he didn't mean low deductible HSAs, but current health insurance plans. So he was saying we currently subsidize women to the tune of $1,000, and HSAs can be seen as simply eliminating that subsidy. As a quick response to that, I have no problem subsidizing individuals for medical needs beyond their control, and would prefer a system that subsidizes cost-effective care on grounds of both justice and efficiency, so I find the point unconvincing. But there it is.
