As Americans prepare their taxes, we are all taking a closer look at where our money goes, For millions of families, one expense stands out: healthcare. And too often, we have little control over how those dollars are spent.
For decades, a growing share of every paycheck has been routed into a healthcare system built around third parties: insurers, middlemen, and government bureaucracies. In that system, individuals pay more but see little return in savings, transparency, or long-term security. Premiums rise. And families are left with no savings, no equity, and no control over how their healthcare dollars are used.
Health Savings Accounts offer a better model. They put individuals at the center of the system. They do so by applying a principle conservatives understand well: Ownership changes behavior.
IT’S TAX SEASON: HOLD THE IRS ACCOUNTABLE FOR MOVING COMPLIANCE GOALPOSTS
An HSA works like a 401(k) for healthcare in the ways that matter most: ownership, portability, and long-term value. The money belongs to you. It rolls over year to year, grows tax-free, and goes with you when you change jobs. You can use it today for medical expenses or invest it for the future.
Ownership matters. When people control their own dollars, they ask questions, compare prices, and weigh costs before care is delivered. Over time, those choices discipline costs in ways centralized systems never can.
At their core, HSAs rest on a simple idea: The person in the exam room should control the healthcare dollar. Contributions are tax-advantaged, growth is tax-free, and withdrawals for qualified medical expenses are untaxed.
This is not underinsurance. HSA-compatible plans still protect families against catastrophic medical events. What changes is the incentive structure — individuals have both the resources and the motivation to make cost-conscious decisions before care is delivered.
Yet despite broad support, federal policy still treats HSAs as if they were frozen in 2003.
Current law ties HSA eligibility to a narrow set of “high-deductible health plans,” locking out millions of Americans who want the ability to save for healthcare but are told they cannot. More than 140 million Americans with traditional insurance now face record-high healthcare costs while being barred from opening an HSA, not because they don’t need one, but because Washington forbids it.
No one would tolerate this logic anywhere else. We don’t restrict access to IRAs or 401(k)s based on the type of employer-sponsored retirement plan someone has. We don’t limit 529 education accounts based on the kind of school a child attends. Yet with HSAs, one of the few tools that actually helps families prepare for medical expenses before a crisis, we do exactly that.
The result is predictable. It reflects a healthcare system built to manage spending through institutions instead of trusting individuals. The result is predictable: higher costs, less transparency, and fewer incentives to prevent illness instead of treating it.
That’s why expanding HSAs fits squarely within a conservative approach to healthcare reform. Any serious healthcare reform must start with a basic truth: Healthcare dollars should flow to individuals, not through layers of bureaucracy and insurance middlemen. HSAs already embody that principle. The question is whether Washington will finally remove the barriers that prevent more Americans from accessing them.
The market has already spoken. More than 40 million Americans hold HSAs today, with combined assets exceeding $150 billion. That is not a niche product — that’s proof of concept.
A recent national survey commissioned by the Great American Health Alliance shows strong support for healthcare accounts that roll over and grow tax-free for life. Large majorities want portability, personal control, and the flexibility to spend on prevention and wellness, not just sick care, after costs spiral out of control.
The fix is straightforward. Congress should take two simple steps. First, decouple HSAs from high-deductible health plans and allow every American to open one. Second, expand eligible uses to include insurance premiums.
This is not a call for a new entitlement or government program. HSAs are privately owned accounts. They rely on markets, incentives, and individual decision-making. They reward planning over panic and prevention over crisis.
Healthcare costs won’t come down by adding another layer of bureaucratic control or increasing subsidies. They will come down when Americans are trusted to manage their own healthcare dollars.
HSAS CAN SHIFT POWER TO PATIENTS. TRANSPARENCY MUST COME FIRST
As Tax Day approaches, every American should ask a simple question: Why can’t I own my healthcare savings?
In a free society, that should not be a radical question. Until policymakers answer it, families will keep paying more for a system that gives them less.
Scott Cutler is CEO and President of HealthEquity, the nation’s largest Health Savings Account administrator.