All of the patient information was recorded from 2016 through 2019. The patients in the data were adults ages 18 through 64 who had employer-sponsored coverage along with diagnoses of asthma, diabetes, high blood pressure, coronary artery disease, heart failure or major depressive disorder.

About 61.6% of the patients with ordinary health coverage received the standard recommended care, such as two blood sugar tests per year for people with diabetes. Only 56.8% of the patients with HDHP coverage received coverage care. Those figures mean that the patients with HDHP coverage were 7.8% less likely than the other patients to get the recommended care.

HDHP use cut the odds that patients with chronic conditions would get the recommended number of office visits by just 4.1%, to 72.1%; the recommended lab tests by 11%, to 49.1%; and the recommended prescription drugs by 22%, to 30.9%.

HDHP enrollees with heart failure were about 7% more likely to get the standard recommended care than the enrollees with other conditions.

HDHP enrollees with the other chronic conditions included were less likely than patients with other types of coverage to get the recommended care. The impact on the odds of getting the recommended care ranged from a decrease of 1% for asthma to a decrease of 15% for major depressive disorder.

The researchers said the care standards they used in their study are minimal standards, such as one visit to a medical professional per year for a patient with diagnosed heart failure.

"That such basic levels of care are less likely to be met when persons enroll in HDHPs engenders concern," the researchers wrote.

The backdrop: In the United States, employees can combine HDHPs with health savings accounts or use HDHPs without HSAs.

Related: IRS posts HSA, HRA and HDHP limits for 2026

Workers who can contribute cash to HSAs used together with HDHPs can avoid paying taxes on both the contributions and amounts spent on health care services and products.

The designers of the HSA program wanted to encourage the HSA owners to be careful health care shoppers by requiring the HSA users to use some of their own cash, either from the HSAs or their own pockets, to pay ordinary health care costs. The HSA designers forced HSA users to have "skin in the game" by requiring to use the accounts with HDHP coverage. Because so many HDHP users have HSAs, the rules for HSA-compatible HDHP coverage have a big effect on all HDHPs.

The Affordable Care Act changed the HSA-compatible HDHP coverage world by requiring HDHPs to pay for some types of high-value preventive care, such as checkups and vaccinations, without imposing deductibles, copayment bills or coinsurance bills on the enrollees.

In recent years, policymakers have been trying to make the preventive services coverage rules for HSA-compatible HDHPs friendlier to patients who already have chronic health conditions.

House Ways and Means Chairman Jason Smith, a Missouri Republican, and two colleagues recently asked the Internal Revenue Service to let the plans expand pre-deductible coverage guidelines to add more items aimed at people with chronic health problems.

A House bill, the Chronic Disease Flexible Coverage Act, would make the current IRS guidelines federal law and make it easier for the IRS to add to the list of items eligible for pre-deductible coverage.