Medicaid, the government health care plan for people with low incomes or disabilities, provides insurance to nearly 51 million people.
The states and the federal government jointly fund Medicaid. It costs states on average about 16 cents per dollar to pay for Medicaid, and that number has been rapidly growing. Because the recession has reduced state budgets, many states have been forced to cut Medicaid benefits, such as dental care.
MSAs are an innovative form of health insurance that advocates say side steps the cumbersome third-party insurance reimbursement that has dominated American healthcare for decades. In doing so, MSAs promise to lower healthcare costs by making individuals responsible for paying for their own care -- and hence more cost-conscious.
At the same time, advocates say that MSAs promise to return to individuals their right to seek out care from any healthcare provider they wish, without the restraints of managed care.
"Patients can have more control over their own resources," says health policy analyst Greg Scandlen. "They have no restrictions on who you can see and not see, and many physicians are willing to provide discounts in return for instant payment. Just as important, it helps to restore the doctor-patient relationship by empowering patients to deal directly with their physicians."
Scandlen is with the National Center for Policy Analysis in Dallas, which has been a major proponent of MSAs.
Here's how they work: Purchase a low-cost, traditional indemnity (non-managed care) insurance plan with high deductibles. Then use the savings from paying a lower premium to make deposits into a tax-deferred MSA. While the insurance company would still pay for high-cost medical episodes, such as lengthy hospitalizations, the individual could use the MSA to pay out of pocket for lower-cost routine care.
The virtues of MSAs were extolled in a 1994 book called Patient Power written by health economist John Goodman, PhD, president of the National Center for Policy Analysis." The vision gained considerable momentum in the years following the Clinton Administration's failure to reform the national health system. Even the American Medical Association voiced their support for MSAs.
In 1996, federal legislation to promote MSAs was enacted as part of HIPAA, the Health Insurance Portability and Accountability Act.
Since that time, however, the vision of MSAs seems to have withered somewhat. Many health policy analysts saw the idea as an innovative one with many virtues -- possibly attractive to some individuals -- but full of shortcomings when it came to answering the larger problem of spiraling healthcare costs.