As candidates spend the coming months telling voters how they would transform American health care, they should not overlook reforms that could make care more accessible and affordable without requiring complex new government programs.
Millions of Americans are already trying to make their health care dollars go further. They compare prices, explore alternatives to insurance, and choose lower-cost ways to obtain prescriptions and routine care. Yet federal policies often penalize them for doing exactly what policymakers say they want consumers to do: shop carefully and choose the best value option.
A practical health care affordability agenda should begin with a simple principle: When Americans use their own money to pay for legitimate health care, government rules should help that money go further.
Policymakers can put that principle into practice in two ways.
First, consumers should receive credit for the money they actually spend on prescriptions.
Consider a consumer whose insurance requires an $80 out-of-pocket payment for a prescription. That same drug may be available for $30 through a cash-pay option. Choosing the $30 price should be an easy decision.
But under many health plans, that spending may not count toward the consumer’s deductible or annual out-of-pocket maximum because the prescription was purchased outside of traditional insurance. The consumer saves $50 at the pharmacy counter but forfeits credit for the $30 spent.
That is not how a system designed to encourage cost-conscious choices should work.
The Every Dollar Counts Act, introduced this year by Rep. Greg Murphy, M.D., offers a straightforward solution that lawmakers on both sides of the aisle should support. It would require out-of-pocket spending on covered prescription drugs to count toward a consumer’s deductible and out-of-pocket maximum regardless of where the medication is purchased.
Americans should not have to choose between finding the lowest available price and receiving the full value of their insurance. If enacted, this legislation would help remove that tradeoff.
Second, Congress should modernize flexible spending accounts (FSAs) and health savings accounts (HSAs) to reflect how people receive health care today. These accounts allow consumers to use pre-tax dollars for qualified medical expenses, but health care delivery is evolving more quickly than the rules governing which expenses qualify.
Consumers increasingly use low-cost memberships that provide access to discounted prescriptions, virtual visits, or other health care services. In many cases, a consumer can use FSA or HSA funds for the prescription or appointment itself, but not for the membership that unlocks the lower price.
Congress has already begun to recognize that health care memberships can be legitimate medical expenses. As of this year, certain direct primary care memberships can be paid tax-free from an HSA under a change implemented through IRS guidance. But that change is narrowly limited, leaving out broader memberships that may combine prescription savings, virtual care, and other services.
Lawmakers should extend the same principle to other health care memberships and to HSAs and FSAs. Clear eligibility standards and reasonable monthly limits could prevent abuse while allowing consumers to use their own health care dollars for services specifically designed to reduce the cost of care.
Neither of these proposals would replace insurance or require Washington to construct a new health care system. They would simply update existing policies to reflect how Americans already seek and pay for care.
Candidates will continue debating ambitious plans throughout the election season. But affordability is also shaped by technical rules with very real consequences: whether a consumer’s spending counts, whether personal health care funds can be used, and whether someone can confidently choose a lower price.
Washington should give people credit for making responsible health care decisions. When Americans find a legitimate way to pay less for the care they need, public policy should reward that choice.
