President Bush renewed his call for expanded use of health savings accounts Wednesday. He also called on Congress to pass a controversial insurance law that would allow business associations to band together to buy medical coverage.

Bush told an audience at the National Institutes of Health in Bethesda, Md., that wider use of high-deductible health savings accounts (search) would help slow rising health costs by making consumers instead of third-party insurers responsible for medical spending.

The president backed the accounts as a way to help spread coverage to some of the 45 million Americans without health insurance, repeating a key portion of his first-term health care agenda.

The accounts became legal as part of the Medicare reform bill signed in December 2003, but more people need to know about their advantages for them to improve the health care system, the president said.

“Part of the issue with health savings accounts is for people to even understand they exist,” he said.

The law allows individuals who buy high-deductible insurance coverage to save money for out-of-pocket health costs in tax-free accounts. The insurance plans typically have lower monthly premiums than standard insurance but often require patients to pay thousands of dollars on their own before insurance kicks in.

Bush touted the plan as a key way to add consumer demand to the health care marketplace by compelling patients to spend more of their own money on care.

“Since HSAs [Health Savings Accounts] enable a consumer to own their own account and manage their own account and make decisions for their account, we've introduced demand into the marketplace,” said the president, who added that he has started an account for himself.

William Lomel, who owns a roofing company in Suwanee, Ga., told Bush that the accounts helped lower his family’s health costs by thousands of dollars per year.

“One of the key things that has come out of this is that when I go to the doctor, I'm interested in the cost,” he said.

Health savings accounts remain controversial, with many critics charging that they encourage younger and wealthier consumers to buy coverage but largely exclude those who cannot afford to pay their own day-to-day health costs.

A study released Wednesday by the Commonwealth Fund (search) concluded that nearly half of consumers with high-deductible plans experience problems paying medical bills, compared with less than a third of patients with traditional low-deductible insurance.

"The evidence is that increased patient cost-sharing leads to underuse of appropriate care," said Karen Davis, the group’s president.

Bush also called on Congress to enact insurance law changes that would allow groups of businesses to join together to buy health coverage for employees. The plans are allowed in some states but are highly limited by laws preventing them from operating in more than one state.

“Congress needs to understand that, on the one hand, you cannot complain about people who don't have insurance and you work for a small business, and then not allow small businesses to be able to have the opportunities in the marketplace,” the president said.

The changes stalled last year in the Senate, where Democrats Wednesday criticized Bush for presiding over rapidly rising health care costs and large increases in the number of uninsured Americans during his first term.

Democrats this week introduced sweeping legislation designed to expand health care access by providing tax credits to small business, allowing consumers to import lower-cost drugs from beyond U.S. borders, and offering health coverage to all children.

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: U.S. President George W. Bush. William Lomel, owner, Titan Roofing, LLC, Suwanee, Ga. Karen Davis, president, Commonwealth Fund.