smjsl,
I think I understand your question and I have the same concerns. We have about $23000 or so in our HSA right now. Maybe $3000 of unreimbursed medical expenses from years past. Which means a net of $20,000 in the HSA for future medical spending.
This $23000 balance may produce earnings of something like $2300 a year (assume 10%). So if I leave the money in the account, it will generate something like $2300 a year in growth (long term average). If my annual medical/dental expenses are less than $2300 a year, then the HSA will grow more rapidly than the medical/dental expenses incurred each year.
My question, I guess like the OP's question, is whether I should keep dumping $6000+ a year into an HSA if most of my future medical expenses will be paid by a gold (or silver or bronze) plated government subsidized health plan. Or medicaid.
Going back to the often quoted Kaiser Health Insurance subsidy calculator for answers:
Health Reform Subsidy Calculator - Kaiser Health Reform
If my family of 4 has income in ER of $31,100, we get medicaid with "modest" out of pocket payments. I think these are the $1 or $5 copays I hear about from those I know who have/had medicaid. If our income jumps to $32,200, we are not eligible for medicaid, but receive a huge subsidy, and pay just under $1000 for the health insurance. Here is the text that makes me think our out of pocket would be limited (assuming an income of $32,200 or thereabouts):
"The guaranteed plan for the person/family will have an actuarial value of 94%. This means that for all enrollees in a typical population, the plan will pay for 94% of expenses in total for covered benefits, with enrollees responsible for the rest."
I think this means that the total of copays and deductibles to the insured for the experience group in the insurance plan will only be 6% of the total medical costs. So if the average policyholder has medical expenses of $11,632 (the total cost of the policy premiums), then I the policyholder cannot pay more than 6% of that I think. Or $697. I have no clue how the mechanics of this would work. Do I receive an additional refundable tax credit if my copays and deductibles exceed the 6% figure (more than $697)?? This type of knowledge is currently above my paygrade.
The bottom line is that if I can keep my taxable income low enough in ER, I may be on the hook for very little in the form of medical expenses year to year. Dental expenses will still be there (and they currently represent more than half our med/dental expenses today WITH dental insurance).
So at the end of the day, I'm not sure I need a whole lot more than $23000 in my HSA, but the alternative is NOT contributing, and guaranteeing I pay the tax on the foregone contributions now instead of maybe getting a tax break each year or worst case, withdrawing at 65.
I may just stick it out for 2011, 2012, and 2013, and keep maxing the HSA since the details of the 2014 health insurance, subsidies, payments, tax treatment of HSA's etc are "subject to change".