Equitable Health Savings Accounts

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See all articles by Samuel Estreicher

Samuel Estreicher

New York University Law School

Clint Wallace

University of South Carolina School of Law

Date Written: November 1, 2018


This Article offers the first comprehensive legal critique of existing Health Savings Accounts (HSAs), arguing that current policy is redistributively regressive, thus exacerbating inequality, and also fails to accomplish stated health care goals. We propose an alternative—Equitable Health Savings Accounts—which uses cash grants as a tool to address both of these problems. The Equitable HSA is a market-based social policy that calibrates size and delivery of a government subsidy to help the least well-off and to facilitate development of and participation in healthcare markets. Equitable HSAs can serve as a model for using cash grants to bridge the gap between Republican social policy proposals that generally carry a market libertarian flavor, and Democratic proposals that are focused on redistribution and social safety nets. Contrary to conventional political wisdom and academic commentary on the tradeoff between equity and efficiency, we make the case that in healthcare delivery, these goals need not be mutually exclusive. Rather, as our Equitable HSA proposal demonstrates, cash grants can allow policymakers to harness the benefits of markets while engaging in redistribution.

Keywords: tax, tax policy, health care, health care financing, HSA, health savings account

JEL Classification: H20, H24, H25, H29

Suggested Citation

Estreicher, Samuel and Wallace, Clint, Equitable Health Savings Accounts (November 1, 2018). 55 Harvard Journal on Legislation (forthcoming 2019). Available at SSRN: https://ssrn.com/abstract=

Samuel Estreicher

New York University Law School ( email )

40 Washington Square South
New York, NY 10012-1099
United States
(212) 998-6226 (Phone)
(212) 995-4341 (Fax)

Clint Wallace (Contact Author)

University of South Carolina School of Law ( email )

1525 Senate Street
Columbia, SC 29208
United States

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