Health Savings Accounts (HSAs) are the only way to actually reduce the cost of providing medical care in the United States. Laura Saunders’ recent Wall Street Journal article on HSAs is quite good in its discussion of how it works and how it reduces medical costs. It carefully maps the contribution limits, eligibility rules, state tax differences, Medicare cutoffs, and penalty traps that now surround this tool.
An HSA has two simple parts: a major medical insurance policy with excellent coverage but a high deductible—at least $1,700 for singles and $3,400 for families in 2026—and a tax-advantaged account funded with deductible contributions. That account pays for doctor visits, wellness care, drugs, and other services below the deductible. Because the money belongs to the patient and any unspent balance stays theirs (turning effectively into an IRA at retirement), people spend carefully and demand the best deal. Providers must compete on price and quality. No more guessing what an insurer or Medicare will reimburse. This pairs with the push for hospitals and doctors to post clear prices in advance for procedures like knee replacements.
Yet only about 42.6 million HSAs exist as of mid-2026. Strict restrictions keep the number far lower than it should be: you must enroll in a qualifying high-deductible plan, cannot have other disqualifying coverage, face annual contribution caps, lose the ability to contribute once on Medicare, and risk penalties for non-qualified withdrawals. Many people also avoid them because the rules feel complex and the high deductible looks risky. Congress has layered on needless complexity that makes the system hard to use.
Congress should scrap those contribution limits, eligibility traps, state mismatches, Medicare restrictions, and penalty rules. The core idea remains simple: high-deductible coverage paired with a personal account that patients control. Clean it up so more Americans can use it freely. That is the path to lower medical prices through real competition, not more bureaucracy and government control.