[2] CDHC plans are subject to the provisions of the Affordable Care Act, which mandates that routine or health maintenance claims must be covered, with no cost-sharing (copays, co-insurance, or deductibles) to the patient.
Proponents suggest the plans increase free-market variables in the healthcare system, fostering competition, which, in turn, lowers prices and stimulates improvements in service.
HSAs are seen by proponents as a way to make healthcare more affordable and accessible in the U.S.[citation needed] The Medicare Prescription Drug, Improvement, and Modernization Act, which included provisions designed to stimulate the popularity of these plans, was passed by Congress in November 2003 and signed into law by President Bush in December 2003.
Banks were empowered to create HSAs, which deliver tax-free interest to the holders, who can then withdraw money tax free to pay for qualified expenditures.
Another type of account in the consumer driven healthcare model is Health Reimbursement Arrangements (HRAs), which are employer-funded, and in which employers receive the tax benefits.
[9] In 2014, when major portions of the Patient Protection and Affordable Care Act are implemented in the United States, high deductible plans and the concept of consumer-driven healthcare may become more popular.
[21] Joseph Newhouse, in summarizing the RAND study, reported that visits to doctors and hospitals decline with higher cost sharing, "although for low income families such cutbacks reduced their use of beneficial as well as unnecessary services and was estimated to have increased rates of death from preventable illness.
"[22] However, proponents counter these findings with studies indicating that CDHCs have broad appeal, provide a new option for the uninsured, and are leading to new incentives for people to be more engaged in managing their health.
The authors concluded that "[p]eople enrolled in CDHPs such as those we studied do not underuse preventive services to any greater degree than do those in traditional PPOs.
"Patient ratings of healthcare are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, the study's lead author.
Consumers are unable to make health care decisions based on cost due to a lack of free market, a system in which price transparency is essential.
[31][32] While cost-estimator tools have become available as part of a broad trend towards consumer-driven health technology in the United States, they often do not use actual negotiated rates and lack quality information.