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May 11, 2000, Thursday, Home Edition
SECTION: Metro; Part B; Page 11; Op Ed Desk
LENGTH: 765 words
HEALTH CARE, BUT ONLY FOR THE YOUNG AND HEALTHY;
POLITICS: MEDICAL SAVINGS ACCOUNTS WOULD CAUSE INSURANCE RATES TO RISE FOR
THE OLD AND SICK.
BYLINE: IRIS J. LAV, Iris J. Lav is
deputy director of the Center on Budget and Policy, Priorities, a
Washington-based advocacy group
Bills moving through Congress often become a tangle of complicated
provisions, the import of any one of which can be hard to discern. The medical
savings accounts expansion grafted onto the Patients' Bill of
Rights, a bill that extends new rights to managed care patients, is a
good example. The White House is hosting a meeting today to push congressional
conferees to finish their work on the underlying bill.
accounts may seem benign, but they pack a powerful potential for trouble. That's
because they benefit the young, the healthy and the wealthy at the expense of
the elderly, the sick and the less affluent.
MSAs are for use only with
high-deductible health insurance policies, policies that pay nothing until a
family incurs between $ 3,000 and $ 4,500 annually in covered medical costs. A
current experiment allows some taxpayers buying such policies or their employers
to make tax-deductible deposits into an MSA. Earnings on funds on deposit in
these accounts are tax-free. Funds that are withdrawn to pay medical expenses
are not taxed. If funds are not used and are left on deposit until retirement,
taxes are deferred and funds may be withdrawn for any purpose without penalty.
Currently, MSA use is limited to people who are self-employed, work in
small businesses or are uninsured. Additional restrictions are placed on amounts
deposited to the accounts and on the terms of the high-deductible insurance
The restrictions were put in place because research suggested
that MSAs lead to "adverse selection," in which one type of insurance is
selected by young, healthy people with low medical costs. When healthy people
congregate in the policies used with MSAs, the insurers can charge lower
premiums for these policies than they would have to if they were insuring a
broader cross-section of the population with varying health statuses.
what happens to older, less-healthy people, as well as those who do not have the
wherewithal to make MSA deposits? They would increasingly be segregated in
conventional, low-deductible plans, which would become more expensive. Many
individuals who most need insurance could be forced into high-deductible plans
and become underinsured or could get priced out of the market and join the
Research suggests that if use of MSAs becomes widespread,
premiums for conventional insurance could more than double over time. According
to the American Academy of Actuaries, "The greatest savings from MSAs will be
for the employees who have little or no health care expenditures. The greatest
losses will be for the employees with substantial health care expenditures.
Those with high expenditures are primarily older employees and pregnant women."
The General Accounting Office conducted a survey of insurers now offering
policies with MSAs and found evidence of the beginnings of just this type of
Despite these concerns, Congress is charging ahead to
make MSAs universally available and to relax other safeguards on their use. Both
the House and Senate versions of the managed care legislation, currently in
conference committee, contain such provisions.
middle-income taxpayers get little tax benefit from making MSA deposits; because
of their relatively low income-tax rate, the tax deduction isn't worth much. By
contrast, MSAs can be attractive for high-income taxpayers even if they have
substantial medical expenses. The tax-free compounding of investment earnings on
the funds in the MSA accounts along with deferral of taxation can be
advantageous for the well-to-do even if the MSA is primarily used as an
investment vehicle and health care costs are paid out-of-pocket.
some MSA providers already tout the advantages of MSAs as an investment vehicle.
In discussing the entry of Merrill Lynch and other investment firms into the MSA
arena, the GAO report took note of "insurers' perceptions that MSA enrollees are
using their accounts primarily as tax-sheltered savings vehicles.
have been sparsely used during the experimental period, partly because the
restrictions on MSAs made them less attractive and inhibited marketing. This may
lull policymakers into a belief that an MSA expansion is harmless, something
that could be traded for better patient protections in other parts of the bill.
Such a belief would be mistaken.
The Patients' Bill of
Rights has important provisions. But the risks that the MSA provisions
pose are so great that it would be better to have no bill than to have a bill
that includes them.
LOAD-DATE: May 11, 2000