As the debate over how to address rising premiums on the Affordable Care Act's exchanges drags on, a recent survey suggests experts are skeptical of plans to lean on health savings accounts (HSAs).
Researchers at Cornell University's Health Policy Center polled a panel of 64 healthcare and health policy experts, and 70% said they believe it would worsen affordability to deposit the value of the recently-expired enhanced premium tax credits into an HSA rather than apply it directly to the premium.
By comparison, 10% of the panelists said they believe it could improve affordability.
In addition, 13% said they believe it would have no real impact on the affordability of exchange plans, while 8% offered no opinion, according to an analysis of the survey published in Health Affairs.
There was some nuance to the answers, however, per the survey. Some experts said that emphasizing HSAs as a way to offset the cost for bronze or catastrophic plans would likely lead to affordability challenges for consumers. But allowing HSA funds to apply toward premiums could help people mitigate costs more effectively, some of the respondents argued.
"Some panelists expected mixed effects, varying by income and health status, or said that the impact would depend on how affordability is measured and on the specifics of the proposal," the Cornell researchers wrote in Health Affairs. "Another panelist noted longer-term affordability could improve as consumers would be more price sensitive to future premium increases."
The researchers also asked the panelists about the potential impacts of requiring exchange enrollees who qualify for fully subsidized plans pay for a small monthly premium, approximately $5 to $10 each month. Most (75%) said they believe this would have a measurable impact on overall enrollment.
More than a third (37%) said they believe it would lead to a decrease in fraudulent enrollment. The Trump administration has rolled out a slew of program integrity measures for the ACA that the White House says are targeted at addressing such enrollments, which some estimates contend are in the millions.
Eighty-one percent of those surveyed also said they believe a policy change that would broadly eliminate automatic re-enrollment for many people with subsidies would have a substantial impact on enrollment. The change is currently set to roll out in 2028.
"A number of respondents referenced a growing literature on the effects of administrative burdens on benefit take-up and retention," the researchers wrote. "As debates over ACA reforms continue, policymakers should be mindful of these possible tradeoffs between administrative requirements and affordability and enrollment."