Health savings account instead of Obamacare? A trojan horse

Update: 12/6/2025  So once again...health savings accounts to replace Obamacare? What if a catastrophic disease like cancer happens and the savings account is depleted? Like Obamacare, this does nothing to control the greed of insurers...it just pays for their increasing greed. GOP plan scales back Obamacare, creates Trump Health Freedom Accounts | Fox News    Trump and the GOP are trying to offer consumers the gift of more choice.  That is NOT  what consumers are seeking. They want to afford insurance, of course, but not insurance that would run out in the midst of the onslaught of a catastrophic illness or pre-existing conditions that require huge monthly outlays.  They want coverage that works; not a half-baked substitute that does not.  Health Savings Accounts, Backed by GOP, Cover Fancy Saunas but Not Insurance Premiums - KFF Health News

Update: 11/24/2025; An interesting about-face? Originally, Trump floated the idea of just giving money to those who need health insurance, and others proposed putting that into already existing health savings accounts. He made a big deal of going around the "middlemen", the insurers, and putting the money in the hands of consumers. That proposal got pushback: The problem: What happens when someone gets a catastrophic health problem and uses up the paltry amount in their account? Go bankrupt or sell their homes? Someone got to Trump: the insurance lobby? Now he favors extending Obamacare with some restrictions that will also limit who can qualify for the subsidized insurance offerings.

Continuing with the original post 

It looks like the GOP is going to try to substitute Obamacare with a health savings account...a long-time conservative proposal. The problem is that if you have a catastrophic illness like cancer, plan on going bankrupt or selling your home to pay the bills. What might happen is that those with means will buy catastrophic insurance out of their own pockets, and everyone else will just be taking a risk that they do not get seriously ill. If you have a pre-existing condition, good luck in finding catastrophic insurance you can afford. This is is gift horse that is a Trojan horse. The gift horse, say conservative think tanks and Trump, gives consumers more choice and cuts out the middleman, but what consumers want more than choice is efficient, affordable, and adequate coverage. By itself, health savings accounts are not adequate, and insurance middlemen still play a role.. They have to be combined with other insurance to be adequate.

FYI: Obamacare, so much hated by the GOP and now so popular with public opinion, is actually based on the plan instigated by a Republican governor. The 2006 Massachusetts healthcare law, commonly known as Romneycare  share several key features and architects with Obamacare.  "The insurance company lobby is a powerful one and whatever Trump says about the middlemen and insurers, guaranteed: the GOP Congress will not cross insurance companies...nor will Trump.

The only plan for consumers that gets rid of the middleman, gives consumers choice, is efficient, affordable, and adequate, would be Medicare for All..

So what about the interim when this all-new approach has to be established by law? Trump proposes a $2k gift to everyone. A person I know with treatment for a pre-existing condition said it would cover one month of his medical expenses.

From the Washington Post article: https://www.msn.com/.../gop-plans-to-replace.../ar-AA1QwZqC

"But FSA money generally can’t be used to pay premiums — meaning that patients would be on their own when it came to paying the regular monthly costs to stay insured.

FSAs are “great for buying eyeglasses and going to the dentist, but if you have a catastrophic health event, they’re not going to help,” said Thomas Buchmueller, a University of Michigan economist who served in the Biden administration. "

Health savings accounts have existed since 2004 and are used in combination with other insurance plans, such as employer-provided insurance and catastrophic insurance. As a stand-alone substitute for Obamacare/ACA, it is not, and if combined with Obamacare and subsidized by the federal government, there are serious repercussions to consumers. Health savings accounts were discussed during the debate on the establishment of Obamacare and rejected. Obamacare could collapse under Trump’s new plan, policy experts say - POLITICO

Even in existence, the health savings accounts have had problems: (per my Google AI search)

• Eligibility Restrictions: To be eligible for an HSA, an individual must be enrolled in an HDHP, which can expose them to high out-of-pocket costs before the deductible is met. (My observation: it has only been approved when combined with another insurance plan...so insurers still get their cut and the middle man is still involved) 
• Cybersecurity Threats: The growing value of HSAs has made them a prime target for cybercriminals and fraud, leading to security incidents and the need for robust account protection measures.
• Underutilization of Investment Potential: While funds can be invested, research indicates that only a small percentage of HSA owners invest their balances. 

GOP plans to replace Obamacare have failed. Here’s what lawmakers propose now.