NY and NJ have large enough populations to test market the concept, and we have seen the results there. IMO, if we went nationwide with the concept of guaranteed issue and community rating, small carriers that can't get a good handle on risk assessment will be driven out of business, leaving us with an oligopoly of only large carriers like United HealthCare. These carriers, especially at first, will charge exhorbitant rates, until they can get a better handle on the risks associated with guaranteed issue of coverage. Lower income families will forego coverage which will result in further inflation.
Martha, I have a lot of confidence that HSA usage will continue to rise over the next several years. I don't think that their effects will be immediate. Of course, it will take some time before employers as well as individuals learn how to use them and understand how to use them to their advantage.
If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration.
I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr.
We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic.
There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around.
Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000.
http://www.treas.gov/offices/public-affairs/hsa/pdf/fact-sheet-dramatic-growth.pdf
Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself.