Congress Can Fix Medicare – RedState
Emerging from the federal government shutdown, health care has once again returned to the forefront of the national debate. Amid all this criticism, one truth is clear: America’s health care system remains bloated, expensive and unsustainable.
For years, Congress has excelled at identifying what’s wrong, but struggled to come up with practical, liberal alternatives. Ironically, one of the best solutions already exists under current law, the Medicare Medical Savings Account (MSA). This neglected program could inject competition, transparency and consumer choice into an increasingly bureaucratic Medicare system.
The Centers for Medicare and Medicaid Services (CMS) describes an MSA as “a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account. Enrollees in Medicare MSA plans may initially use their savings account to help pay for health care, then will receive coverage through a high-deductible insurance plan once they meet their deductible.”
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In short, MSAs are Medicare-funded, HSA-like accounts that allow patients to manage their own healthcare budget. Instead of relying on insurance or government monitors, beneficiaries can use funds in their account to pay for care directly. Once the deductible is reached, the insurance component covers larger medical costs.
Unlike traditional Medicare, MSA plans fully cover costs above the deductible, meaning the enrollee’s financial exposure is limited. Each year, the risk of an MSA plan is finite and predictable, equal to the deductible minus the Medicare deposit in the account. In contrast, traditional health insurance carries theoretical unlimited risk, as it only covers 80% of costs, with no annual maximum to pay.
The contrast is even greater when we consider that MSA funds are rolled over from year to year. Savings from well-managed health care accumulate, increasing the balance available to cover future expenses. Over time, a patient who manages their care effectively may reach a point where their MSA balance exceeds their deductible, resulting in no out-of-pocket costs in a given year.
This simple change has transformative potential. When patients control their budget, they become savvy consumers, seeking quality and price. Suppliers must then compete for market, driving efficiency and innovation. An engaged older population, motivated to seek value, would reduce costs while rewarding high-quality care, thereby reforming the entire system, even for those not covered by Medicare.
The recently passed One Big Beautiful Bill (OBBB) expands this potential by allowing MSA funds to finance direct primary care (DPC). DPC practices offer unlimited visits, same-day appointments and telemedicine for one low monthly fee, eliminating insurance bureaucracy.
Studies show that patients with CPP experience better outcomes and reduce their total medical expenses by approximately 20 percent. For seniors, this means improved access and affordability without adding new government programs or taxes.
Although they have been authorized since 2007, Medicare MSAs remain one of the least used options in the entire system. In 2024, fewer than 5,000 beneficiaries nationwide were enrolled.
The problem is not the product; it’s the lack of consumer awareness. Few insurers market MSAs, few policymakers promote them, and most seniors have never heard of them. The result: a powerful free-market reform tool left unused as Medicare spending exceeds $1 trillion a year.
This is a solution that requires neither new bureaucracy, nor sweeping legislation, nor partisan gridlock. The structure is already there; all that is missing is awareness and leadership.
If Congress wants to champion serious, patient-centered Medicare reform, it should start by expanding and promoting MSAs.
This would give seniors real control over their care and reintroduce the fundamental market forces that control prices. Instead of being passive recipients in a government-run system, older adults would become empowered consumers, the kind who ask how much care costs, demand quality, and act as their own listeners.
MSAs align perfectly with American principles: individual choice, financial responsibility, and freedom from unnecessary government control. MSAs re-empower the people Medicare serves most, our seniors, while bending the cost curve in the right direction: through competition and transparency, not through rationing and regulation.
The path to modernizing Medicare and empowering millions of Americans isn’t hidden in a think tank’s white paper. It’s right in front of us. Now it’s time to use it.
Chad Savage, MD, is the founder of YourChoice Direct Care, policy advisor to the Heartland Institute, and founder and president of DPC Action.
Editor’s note: President Trump is leading America toward the “Gilded Age” while Democrats are desperately trying to stop him.
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