Opinion: The life-and-death stakes of the debate over Affordable Care Act subsidies

"A new idea is now gaining traction among some lawmakers: Let the subsidies expire and replace them with federal deposits into health savings accounts. These deposits wouldn't lower the cost of buying a plan. Instead, the proposal assumes that people would purchase cheaper, limited coverage such as high-deductible or catastrophic plans, which often come with deductibles around $6,000 and then use the HSA funds to help pay the medical bills those plans don't cover."

"But HSA deposits do nothing to prevent the real harm. The health consequences of losing insurance or of having insurance that is difficult to affordably use are well-documented. A substantial body of research shows a clear relationship between lack of comprehensive coverage and higher death rates. The U.S. Supreme Court once observed that the power to tax involves the power to destroy. In the context of health insurance, the converse is true: Withdrawing support for comprehensive coverage can be destructive as well."

Congress faces an imminent decision about expiring Affordable Care Act subsidies that, if not extended, could double premiums for many people. A proposal would end subsidies and instead provide federal deposits to health savings accounts, assuming people would buy cheaper, high-deductible plans and use HSA funds for uncovered bills. HSA deposits would not reduce plan prices or ensure affordable access to comprehensive care. Research links lack of comprehensive coverage to higher death rates. Withdrawing support for comprehensive coverage can reduce access to care and cause serious health harms beyond financial strain.

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