Health Savings Accounts — The Ownership Society in Health Care

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Abstract
When President George W. Bush, in his second inaugural address, described his vision of an “ownership society,” he specified not only the ownership of homes, businesses, and retirement savings, but also that of health insurance. Today, the most visible embodiment of this goal in the health care sector is the health savings account (HSA), which reflects a philosophical shift in emphasis from collective to individual responsibility for the management and financing of care. HSAs form the core of the emerging “consumer-directed” insurance plans, imposing greater cost sharing on enrollees but permitting broader choices than the health maintenance organization (HMO) plans of the managed-care era. Although they are compatible with employment-based insurance, HSAs were authorized by the Medicare Modernization Act of 2003 in part to facilitate a shift toward tax-favored but individually purchased coverage.

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