Hoover Institution (Stanford, CA)— Two measures developed by Hoover scholars that became law last year have enabled ten million recipients of subsidies under the Affordable Care Act (ACA) to better take charge of their own healthcare journeys.
One of the new provisions in the One Big Beautiful Bill Act allows recipients of certain “bronze” and “catastrophic” plans offered through the ACA to use Health Savings Accounts (HSAs) for the first time.
The changes also allow all HSA holders to use their accumulated funds to pay for primary-care service fees, also known as primary-care practice membership or subscription fees.
The ideas came to Hoover fellows Lanhee J. Chen, Daniel Heil, and Tom Church, members of Hoover’s Healthcare Policy Working Group, as they began an effort in 2023 to assist policymakers in developing new ides in the healthcare space.
Over the course of five months, Chen, Heil, and Church developed The Choices for All Project, a report that urges Washington, DC, leaders to grant American patients more opportunities to control their own healthcare expenditures and provide better access to the prices and quality information that drives the quality of healthcare they receive.
In July 2023, they presented their work at the Hoover Institution’s Washington, DC, office and in meetings with congressional staff, then followed up with briefs on expanding access to HSAs under the ACA. In 2025 their recommendations made their way into law, which included HSA changes and improvements to primary-care access that the fellows proposed.
“At the core of the Hoover Healthcare Policy Working Group’s efforts is a desire to have real and tangible impacts in policymaking,” said Lanhee J. Chen, cochair of the Hoover Institution’s Healthcare Policy Working Group. “Our ongoing work to expand access to HSAs is an example of how we take ideas and translate them into action. We look forward to more policy and regulatory victories ahead.”
The team estimates that about one million ACA enrollees will utilize HSAs for the first time in 2026.
Since this breakthrough, the Healthcare Policy Working Group has created a range of new policy recommendations, with the aim of helping the federal government and states manage Medicaid costs, streamline the drug evaluation process, and advance market-based solutions to today’s healthcare challenges.
