Abandon High‑Deductible Health Plans Linked to Health Spending Accounts | Jeanne Lambrew

In this episode of Health Affairs This Week, host Jeff Byers interviews Jeanne Lambrew from the Century Foundation about her article calling for the abandonment of high-deductible health plans linked to health spending accounts. Lambrew traces the history of deductibles in U.S. health insurance from the mid-20th century, highlighting how conservative policy ideas from the 1990s evolved into major legislative changes—such as the 2003 Medicare Modernization Act and the 2023 One Big Beautiful Bill Act—that expanded access to health savings accounts (HSAs) and high-deductible plans. She argues that these plans fail to deliver on promises of increased price transparency and consumer shopping, especially given that most healthcare spending is driven by a small fraction of patients with serious or chronic conditions. Despite the growth in high-deductible plans—now at 40% in the individual marketplace—research shows they do not significantly reduce overall spending and instead discourage necessary care, particularly among vulnerable populations. Lambrew advocates for eliminating deductibles altogether, pointing to Medicaid as a model of low-cost, high-access care, and proposes policy solutions like expanding premium tax credits to cover no-deductible gold plans and raising minimum value standards for employer coverage. She warns that the current trajectory under the Trump administration risks worsening the healthcare affordability crisis. The episode underscores a growing tension between market-based reforms and the need for systemic government intervention to control costs and ensure access. Key takeaways include the limited effectiveness of consumer-driven healthcare models, the regressive impact of high deductibles on sick and low-income patients, and the feasibility of policy-driven alternatives that shift financial risk from individuals to public systems. Lambrew emphasizes that real cost reduction requires structural reform, not individual responsibility.