These policies are misguided and would do little to preserve access to affordable, comprehensive coverage.

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As a marketplace enrollee in Pennsylvania said, “The whole point of insurance is to try to, right when you have the problem, nip it in the bud.”

HSAs are not the answer to health care affordability and cash is not coverage. HSAs offer little financial protection or access to affordable health care for people with low and moderate incomes. Extending PTC enhancements helps people afford coverage to get the care they need when they need it.

All 9 HSA providers studied had at least one fee associated with their HSA – some of which are waived for balances exceeding a certain amount. This could mean people with low incomes unable to contribute thousands to their HSA accounts would be further penalized by predatory fees.

If Congress does not extend PTC enhancements, people with low and moderate incomes, Black and Latino people, and people with pre-existing conditions will face the greatest challenges in affording coverage.

Among those with HDHPs, more than half of people with reported excellent or very good health had tax-advantaged savings accounts like HSAs, compared to just one-third of people with self-reported fair or poor health.

Wealthier, healthier, white, and Asian individuals are the most likely to have HSAs.

Among individuals with HDHPs, Asian (54%) and white (50%) individuals were more likely to have tax-advantaged savings accounts like HSAs than Black (42%) and Hispanic or Latino (34%) individuals.

Twice the share of individuals with incomes above 1000% FPL ($150,000 for an individual) with high-deductible health plans (HDHPs) had tax-advantaged savings accounts, including HSAs, compared with people with income below 275% ($41,250) FPL.

If Congress does not extend PTC enhancements, marketplace enrollees in every Congressional district would face steep premium tax increases and similar struggles.

Other proposals that don’t make premiums more affordable would leave people without coverage.

A 40-year-old website tester in PA put it, “The whole point of insurance, is…right when you have the problem, you try to nip it in the bud, as opposed to sacrificing your health for a whole year.”

Michael, a 34-year-old ride share driver in AZ, said “If it [PTC enhancements expiring] does happen, we’ll have to cut costs elsewhere and that’s digging into basic necessities like food, car, gas, all this stuff, rent. We’re struggling already as it is.”

Many marketplace enrollees are hardworking individuals and families who often depend on marketplace coverage to be able to work.

Take Olivia, a 22-year-old nursing assistant in MI: “[Having health insurance is] huge in making sure that I can work and support my family.”

Losing PTC enhancements would hurt people in many ways.

Tracy, a 57-year-old customer service rep in GA said, “If plans become unaffordable then we’re not just losing coverage, we’re losing security, stability, peace of mind. We need those plans to keep health care within reach.”

Read more from @centeronbudget.bsky.social about why HSAs and other proposals won’t make coverage more affordable and do little to help the people who would hurt the most from expiring premium tax credit enhancements.