Create a health savings account
Donald Trump
"Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate."
Trump-O-Meter
Promise Broken
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Health Savings Accounts allow people to save and invest with several tax advantages. People don't pay taxes on the dollars they put in the accounts, and so long as they spend the money on health care, there's no tax on the gains when they make a withdrawal.
The thing is, HSAs have been around since 2003, so Trump was essentially promising to expand something that already existed.
Over the years, there has been interest in letting people put more money into these accounts — the current yearly limit is $7,100 per couple — or passing new rules that could increase the number of people eligible to invest this way.
Neither has happened. Over the years, there have been regular small increases to the contribution limits. But at the same time, the size of the deductible that allows a plan to offer an HSA has also gone up. Beyond those routine adjustments, there have been no large shifts.
The federal response to the coronavirus did relax the rules on how people can spend their HSA dollars. They now can use them to buy nonprescription drugs, menstruation products, and telehealth services. (One feature that isn't new but is potentially useful for the newly unemployed: HSA dollars can go toward health insurance premiums under the benefits law called COBRA.)
Currently, only insurance plans that qualify as high-deductible plans can include an HSA option. A bill is in the works that would allow any insurance plan to include the feature. Its backers in the HSA industry hope to see it pass as part of a pandemic recovery package. That would represent a major expansion, and we will update this promise if it passes.
The option to buy over-the-counter drugs and the like notwithstanding, the HSA landscape remains the same as when Trump took office. We rate this a Promise Broken.
Congressional Research Service, Health Savings Accounts, July 31, 2018
UHC, HSA 2020 guidelines, accessed July 14, 2020
New York Times, Health Savings Accounts Add Options in Pandemic, Including Telehealth, May 1, 2020
U.S. News and World Report, New HSA Account Rules, June 12, 2020
Email exchange, Alison Moore, vice president for marketing, Health Savings, July 15, 2020
Email exchange, Communications Office, Conduent, July 15, 2020
Health Savings Accounts allow people to save and invest with several tax advantages. They don't pay taxes on the dollars they put in, and so long as they spend the money on health care, there's no tax on the gains when they make a withdrawal.
Personal health finance experts told us that President Donald Trump's promise had them scratching their heads when he first listed it on his campaign website. These tax-free accounts have been around since 2004, and they already could accumulate.
So the promise involved expanding these accounts by letting people put more money into them -- the current yearly limit is $6,750 -- or passing new rules that could increase the number of people eligible to invest this way.
Either way, so far, there has been no movement. Not in the recently passed tax overhaul, nor anywhere else.
"The bottom line is that there are no HSA provisions in the tax law and despite interest by members of Congress and the administration to make some changes, nothing has happened," said Paul Fronstin with the Employee Benefit Research Institute, a research group funded by pension funds, unions, investment firms, benefits consultants and others.
Pat Jarrett, the founder of Health Savings Administrators, a company that sells HSAs, echoed that.
"There's been a lot of rhetoric and a lot of talk, but nothing has changed," Jarret told us.
We reached out to the White House and did not hear back.
Given the lack of movement on this promise, we rate it Stalled.
Donald J. Trump website health care reform page
Internal Revenue Service, Health Savings Accounts and other tax-favored health plans, Feb. 12, 2017
Interview, Paul Fronstin, director, Health Research and Education Program, Employee Benefit Research Institute, Dec. 19, 2017
Interview, Pat Jarrett, co-founder, Health Savings Administrators, Dec. 21, 2017