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10 November 2016

Trumpcare: For the Rich and Healthy

I was looking at the presumed plan which states "Fully repeals Obamacare and replaces it with Health Savings Accounts".

What does that mean for the average consumer?  Most employers offer HSAs as an option to their employees. Let's take a closer look at an actual first-hand use case.

First, we must understand that the 'H' in HSA stands for High-Deductible.  The trade-off is usually lower monthly bills. In most plans, you can assume that high deductibles can only benefit you if you never need to file a claim.  This is true whether it is health insurance or car insurance.

Many companies make you work for a full 1-2 pay periods before you get your first paycheck.  When I started Sharp Labs the second time, I was paid monthly.  That meant I had to work for two full months before I got my first paycheck (sucks, I know).  Once I started receiving pay, I would have to get caught up on bills - so I decided to try the HSA.  Lower monthly bills and saving some money tax-free sounded like a good option.

I don't honestly remember what the numbers were on the plan at the time - so let's take a look at the most likely comparable that Providence is offering in 2017.
HSA Qualified 6000 Bronze [PDF]
$257/mo premium + up to $500/mo into HSA
Individual deductible $6000 in-network
Medications 20-50% after deductible

So using this one as an example, I would pay $757/mo to have the health insurance.
One of my meds at the time was $2000/mo (it's down to $1500/mo now). 
This HSA will not pay a dime towards it until I have paid $6000 of my own money towards my medical bills. (I'm pretty sure my deductible was much higher back then)
Since I was not able to pay $2757/mo for health insurance and just one of my medications, I was unable to pay for my medications and doctor visits.

Doctors were upset that I was skipping all my appointments (couldn't afford them on the HSA).
Doctors were upset that I was not taking my medications (couldn't afford them on the HSA).

In August of that year, I was hospitalized for 2 weeks because I couldn't afford to take my medications.
The hospital and doctor bills (multiple, not aggregated) would take me years to pay off.
The cost of that visit was high enough that the HSA finally kicked in.
For Sept-Dec, I was finally able to pay only $1000/mo for that medication (using the example 2017 HSA above).

So, long story not-so-short... If you are never sick, never see your doctor for anything and never take any medications; HSA can seem reasonable.  Any other situation, and it's basically a scam. 

Personally, I won't even accept a job that only provides HSAs for medical.