Republicans claim to support HSAs as a way to encourage smart health care consumption, with minimum insurance coverage mandates, and automatic enrollment as a way to increase coverage. Progressives support public insurance programs, believe everyone should get basic coverage to protect them from medical bankruptcy, and support a public alternative to private insurance companies. Republicans, progressives, and a majority of Americans overwhelmingly oppose an individual mandate forcing Americans to buy a product from private insurance companies, or face getting fined by the IRS.

A bipartisan policy compromise would be to scrap the current individual mandate and replace it with automatic enrollment in a HSA combined with only a very minimal public extreme catastrophic insurance policy.