Solving America's healthcare affordability crisis requires universal HSA access

Key Takeaways

• Broader access to Health Savings Accounts (HSAs) would materially strengthen America’s healthcare safety net, enabling Americans to save for qualified medical expenses, regardless of insurance type.
• HSAs offer a unique triple-tax advantage, making them one of the most powerful and underutilized tools for healthcare affordability.
• Restricting HSAs to high-deductible health plans (HDHPs) is an outdated policy choice, not an economic necessity, and it disproportionately harms working families.
• HealthEquity is advocating for policy changes to expand HSA eligibility and benefits.

America’s healthcare affordability crisis is widening — and millions are at risk. HSAs offer a way to help close the gap. HealthEquity, an original architect of HSAs and the nation’s largest HSA custodian by assets, calls for modernizing HSA policy to reflect today’s healthcare and economic realities. Research shows HSA holders are better prepared for routine bills and 50% less likely to skip necessary care because of cost.¹ Expanding eligibility, with legislation like the HSAs for All Act, could be a game changer.

By the numbers

The healthcare affordability gap

• 50% of American adults can’t afford to pay a $500 medical bill in full, revealing a structural savings failure, not a spending problem.²
• 9% projected jump in healthcare expenses in 2026 — the steepest increase in 15 years – outpacing wage growth.³
• More than 10% of Americans have already tapped retirement savings to cover medical care, undermining long-term financial security.⁴

Who can access an HSA today?

Under current federal law, HSA eligibility is tied exclusively to enrollment in a qualified high-deductible health plan (HDHP).

This policy:

• Excludes roughly 140 million Americans⁵
• Penalizes individuals for choosing plans that better fit their medical needs
• Limits the reach of one of healthcare’s most effective affordability tools

3 policy priorities to modernize healthcare savings

1. Universal HSA access

We must remove the requirement that ties HSA eligibility to HDHPs. Every American should be able to build a dedicated portable healthcare savings account without being forced into a specific plan structure.

Universal access would:

• Strengthen household financial resilience
• Preserve consumer choice
• Eliminate inequitable eligibility barriers

2. Expanded use for premium payments

Allow HSA funds to be used for qualifying insurance premiums beyond today’s narrow exceptions. This flexibility would give individuals greater control over their healthcare spending decisions, ensuring funds are used where they are needed most.

3. National awareness and financial education

Access alone is not enough. Public-private partnerships must expand education around HSAs to increase adoption, literacy, and long-term savings behaviors.

Why HSAs are structurally different

HSAs are one of the most tax-advantaged accounts⁶ recognized by the IRS, offering:

1. Tax-free contributions: Money goes in pre-tax, lowering your taxable income.
2. Tax-free growth: Interest and investment earnings grow without being taxed.⁷
3. Tax-free distributions: Money used for qualified medical expenses is never taxed.

This structure uniquely positions HSAs to help reduce medical debt, protect retirement savings, and stabilize household finances over time.

Frequently Asked Questions (FAQs)

Can I have an HSA without an HDHP?

Currently, you must have an HDHP to open an HSA. However, HealthEquity is advocating for universal HSA access, which would allow all Americans to open and contribute to an HSA regardless of their insurance plan.

Should everyone be able to open an HSA?

Absolutely. HealthEquity believes that every American deserves access to the powerful, tax-advantaged savings that an HSA provides. We are leading the way in advocating for universal HSA access to help all individuals and families better manage rising medical costs and increase their financial security.

Do HSA funds expire?

No, HSA funds do not expire. Unlike Flexible Spending Accounts (FSAs), your HSA funds roll over year after year, allowing you to build long-term savings.

Is an HSA a “use it or lose it” account?

No, HSAs are not “use it or lose it.” Your funds remain in your account indefinitely and can be used for qualified medical expenses at any time.

Can I use my HSA to pay for health insurance premiums?

Currently, HSA funds can only be used for premiums in limited cases, such as COBRA or long-term care insurance. HealthEquity is advocating for policy changes to allow qualifying premium payments for all HSA holders to increase financial flexibility.

What happens to my HSA if I change insurance plans?

Unlike an FSA, your HSA is yours to keep. Even if you move to a plan that isn’t an HDHP, you can still use your existing funds for qualified medical expenses tax-free.