HSAs Are Good. HSAs Plus Direct Care Are Better.

I've admired Sally Pipes for more than 20 years. In a recent Washington Examiner piece, she pushes back on a Georgetown proposal that would cap deductibles and, by the authors' own description, sunset health savings accounts. She's right. Killing HSAs is backward.

She cites a study of more than 76,000 people at 709 employers. HSA enrollees spent roughly 5% to 7% less on health care. That's real money.

But here's my worry. The average family premium for job-based coverage is now nearly $27,000, per KFF. ACA benchmark premiums rose about 22% for 2026, per the Urban Institute. A lot of families pay the premium and have nothing left to put in the account. Telling them to save more can feel a little like "let them eat cake." To her credit, Sally suggests targeted help for lower-income households. I'd add one more tool.

Direct primary care.

One flat membership. Unlimited visits. No copays. At our clinics, meds and labs at wholesale, often a small fraction of retail. Procedures that would cost hundreds elsewhere, included.

That changes what an HSA dollar buys. Same dollar, many times the care.

And it's now official. Since January 1, 2026, people in a qualifying DPC arrangement can contribute to an HSA and pay the membership with HSA money, up to $150 a month for an individual.

I am not anti-insurance. Keep a policy for the wreck, and pair it with an HSA. Then let direct care handle the everyday.

HSAs give patients the dollar. Direct care makes the dollar worth something.

Sources: Sally Pipes, Washington Examiner: www.washingtonexaminer.com/restoring-america/faith-freedom-self-reliance/4744997/want-cheaper-health-insurance-dont-kill-hsas-preserving-low-premium-coverage/ KFF 2025 Employer Health Benefits Survey: www.kff.org/health-costs/annual-family-premiums-for-employer-coverage-rise-6-in-2025-nearing-27000-with-workers-paying-6850-toward-premiums-out-of-their-paychecks/ Urban Institute, 2026 ACA premiums: www.urban.org/research/publication/understanding-extraordinary-increase-aca-premiums-2026 IRS, HSA + DPC guidance: www.irs.gov/newsroom/treasury-irs-provide-guidance-on-new-tax-benefits-for-health-savings-account-participants-under-the-one-big-beautiful-bill