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

Why It Matters

Expanding high‑deductible plans with spending accounts shifts more health‑care costs onto consumers without reducing prices, threatening access for the sickest patients and prompting urgent policy reconsideration.

Key Takeaways

• High‑deductible plans trace back to 1990s conservative think‑tanks.
• Average employer deductible reached $1,900 in 2025, rising steadily.
• Health spending accounts barely affect overall expenditures, sometimes increase spending.
• Consumers rarely price‑shop; high deductibles reduce utilization, not prices.
• Policy proposals aim to expand catastrophic plans, shifting costs to households.

Summary

The Health Affairs podcast episode focuses on Jeanne Lambrew’s argument to abandon, rather than expand, high‑deductible health plans (HDHPs) paired with health spending accounts. Lambrew traces the policy’s origins to 1990s conservative think‑tanks, noting three legislative boosts—the 2003 Medicare Modernization Act, the ACA’s clarification, and the recent One Big Beautiful Bill—that have entrenched HDHPs with health savings or flexible spending accounts in the market.

Lambrew highlights that average deductibles have climbed to about $1,900 for employer‑based coverage and $2,800 for individual plans, while only one‑third of workers with employer insurance possess a spending account. She stresses that most health spending is driven by a small, sick population—20% of dollars go to the sickest patients—and that high deductibles act as a surcharge for those with pre‑existing conditions. Moreover, research shows HDHPs do not spur meaningful price shopping; utilization drops across the board, and accounts have negligible impact on total spending, sometimes prompting unnecessary purchases to avoid forfeiting balances.

Key examples include the administration’s push to expand catastrophic plans with $31,000 family deductibles and a surge from 2% to 43% of marketplace enrollees selecting plans eligible for health savings accounts. Lambrew also cites the president’s “Great American Health Plan” rhetoric, which frames shifting cost burdens to consumers as the primary solution, despite evidence that such shifts increase out‑of‑pocket strain without lowering prices.

The discussion concludes that without stronger government involvement—such as eliminating deductibles in ACA marketplace gold and silver plans or linking premium tax credits to higher‑value coverage—high‑deductible structures will exacerbate affordability challenges. State‑level experiments may provide a natural laboratory to assess whether expanding HDHPs with spending accounts truly improves cost transparency or merely deepens consumer financial risk.

Original Description

Health Affairs Publishing's Jeff Byers welcomes Jeanne Lambrew of The Century Foundation to discuss her recent Forefront article exploring whether high deductibles and health spending accounts achieve their intended goals and how alternative approaches could improve healthcare affordability and access.

On April 20th, join us for our upcoming Insider exclusive event ( https://www.healthaffairs.org/do/10.1377/he20260313.697167/full/?utm_medium=podcast&utm_source=this+week&utm_campaign=insidermarketing&utm_content=eventspecific ) exploring the evolution of the Medicare Advantage market featuring Sachin Jain, David Meyers, and Grace Mackleby.

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Related Articles:

* Abandon—Don’t Expand—High-Deductible Plans Linked To Spending Accounts ( https://www.healthaffairs.org/content/forefront/abandon-don-t-expand-high-deductible-plans-linked-spending-accounts?utm_medium=podcast&utm_source=this+week&utm_campaign=forefront ) (Health Affairs Forefront)

Health Affairs This Week

Episode 241

April 3, 2026

★ Episode details: https://share.transistor.fm/s/49112cf2

★ Additional episodes: http://www.healthaffairs.org