Equitable Health Savings Accounts

42 Pages Posted: 26 Nov 2018 Last revised: 28 Feb 2019

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-policy critique of existing Health Savings Accounts (HSAs), arguing that the current approach is redistributively regressive, thus exacerbating inequality, and also fails to accomplish stated healthcare goals. We propose an alternative—Equitable Health Savings Accounts—which uses cash grants as a tool to address both of these problems. Equitable HSAs are a market-based social program that calibrates size and delivery of a government subsidy to help the least well off and to facilitate 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, these goals need not be mutually exclusive. Rather, as our Equitable HSA proposal demonstrates, cash grants can strengthen market forces, allowing policymakers to harness the benefits of markets to achieve policy goals 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, 2019 (Forthcoming), Available at SSRN: https://ssrn.com/abstract=3276759

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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