January 01, 2025

Business Group on Health Policy Position Statements

Business Group on Health’s position statements on health policy issues impacting employer-sponsored health coverage.

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Health savings accounts (HSAs) paired with high-deductible health plans (HDHPs) are a valuable plan option to promote potential consumer savings. However, HSAs have some limitations and targeted changes would provide meaningful improvements and investment in the health and well-being of employees and their families.

Since their inception, health savings accounts (HSAs) paired with high-deductible health plans (HDHPs) have grown to play an important role in the plan designs offered by employers. While the current HSA/HDHP design works for many, employers are also interested in certain HSA improvements and considering additional flexibilities to underlying coverage requirements.

As employers focus on providing high-quality, evidence-based benefits while lowering the overall cost of care, they have struggled with certain limitations of the HSA rules. The Business Group successfully advocated for the adoption of permanent improvements to HSA-qualified health plans to permit pre-deductible telehealth services and direct primary care arrangements. But we have more HSA improvements that we believe would be beneficial for employees and their families. Specifically, employers would like to cover certain evidence-based benefits such as chronic care management and certain preventive medications before employees satisfy their deductibles.

Position

Additional flexibility in HSA rules would allow HSA/HDHP arrangements to deliver on the design’s underlying goals—more efficient health care purchasing and increased patient engagement in health care decisions. Specifically, we support:

Greater flexibility for pre-deductible coverages that have proven value, including:

• Allowing plans to cover chronic condition management and medications;
• Allowing plans to cover onsite clinic services and other lower cost alternative sources of health care;
• Allowing plans to incorporate evidence-based benefit designs and risk sharing models;
• Allowing plans to provide medical travel benefits with greater flexibility;

Improving access, supporting design innovation, and promoting consumer education and choice, including:

• Flexibility to adjust how deductibles apply to certain higher-cost items or services, such as those that involve copayment assistance or copayment waivers;
• Flexibility for Medicare-eligible employees to make HSA contributions; and
• Strengthening transparency in health care with usable price and quality metrics.

WHY IT MATTERS

• Rising health care costs continue to be a major concern for employers and employees.
• Permitting plan coverage of primary and preventive care and medications and services for management of chronic conditions prior to the deductible will prevent the need for more expensive care downstream.
• Coverage of primary care, mental health counseling, and other basic services offered through telehealth, onsite clinics, and other lower cost sites of care will help reduce health care costs for employers and employees.
• HSA funds, including employer contributions, help employees and their families afford their out-of-pocket health care expenses and save for future health care needs, including for retiree health expenses.

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