But for a ton of people that amount is extremely variable. Do you plan on getting into a car accident? Do you plan on getting an appendectomy in June when making your elections the November before? Sorry doctor, getting cancer wasn't in the plans for 2026, can we reschedule that to 2027 after my open enrollment?

I hate FSAs. Anyone have a good argument on why we should have them instead of just making HSAs open to everyone regardless of healthcare plan?

▲

topgrain2 an hour ago | parent [-]

Requiring certain healthcare plans to access HSAs is the only thing that keeps HSAs from primarily being (in terms of amount of tax income lost to the program) a benefit for the upper-middle-class and higher, i.e. a regressive redistribution scheme.

Optimal (maximizing your benefit... and also cost in lost tax receipts) use of HSAs requires not touching the money until retirement. You pay medical bills with non-HSA money and keep the HSA money invested and growing tax-advantaged, like an extra retirement account. Spending the money you put in every year offers relatively tiny gains compared to keeping it in those accounts for decades.

Your options to mitigate this are to limit access, or to make it undesirable to keep money in them long-term, approaches to which look kinda FSA-like.

	▲	vel0city an hour ago \| parent [-]
		> to make it undesirable to keep money in them long-term We could just continue to enforce the 20% penalty indefinitely to get rid of the concept of these accounts turning into retirement accounts. FSAs benefit the upper-middle-class and wealthy more than poor people as well. You'll see quite a bit more savings when your top end tax rate is 35% than 12%. They're also far more likely to be able to plan on setting aside some portion of their incomes into a FSA at enrollment time rather than the bigger effects of the gamble with lower income earners; the outcomes of the risk of overfunding is way more impactful for someone making little money. The tax benefit helping the wealthy more seems to me to move more towards eliminating the tax advantages of healthcare spending entirely.