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“I know Al Gore invented the Internet, but I invented health savings accounts, believe it or not. I was the first member of Congress back in 1992 to introduce health savings accounts in the United States Congress.”

— Rick Santorum (R), speech at Iowa Agriculture Summit, March 7, 2015 

Santorum was among several Republican presidential hopefuls touting their record at the Iowa Agriculture Summit. Each spoke in a question-and-answer format with host Bruce Rastetter about a range of issues affecting the farming industry in Iowa, including the renewable fuel standard, genetically modified organisms and solar energy.

When asked about his stance on Obamacare, Santorum said he believes in consumer-based health care options, such as health savings accounts, that provide flexibility and “not have all your money and power go to Washington.”

Did Santorum “invent” health savings accounts? Was he the first member of Congress to introduce legislation to create them?

The Facts

In January 1992, Santorum introduced H.R. 4130, the Health Care Savings Plan Act of 1992. The legislation proposed an amendment to the Internal Revenue Code, which would allow individuals and families to set up medical savings accounts to make tax-free deposits that later could be used to buy medical services.

Under the plan, Americans could be self-insured for small medical expenditures while using third-party insurance options for more expensive medical procedures. The idea was to give people an option similar to individual retirement accounts, and encourage people to shop around for cheaper health care since they would pay for much of the costs out of their own pockets.

Santorum held a news conference announcing the bill on Feb. 5, 1992, with a coalition of House Republicans co-sponsoring the bill. The chief sponsors were Santorum and John Kasich of Ohio (now the state’s governor and potential 2016 opponent). Former House minority whip Newt Gingrich of Georgia, Richard Zimmer (N.J.), Dan Burton (Ind.) and Tom Delay (Texas) were among lawmakers unveiling the proposal that day. The bill was, indeed, the first proposal for medical savings accounts (MSAs) — precursor to the current health savings accounts (HSAs) — and it laid the groundwork for lawmakers to introduce alternative proposals for such accounts in 1992 and thereafter.

Santorum continued to support such savings accounts in the Senate. HSAs, as they are known today, were authorized by the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Santorum included HSA in the Medicare bill as a member of the Senate Finance Committee, and this “frankly, is one of the sole reasons he voted for it on the floor of the Senate,” said Matthew Beynon, Santorum’s spokesman. Beynon added that “to suggest that anyone other than Senator Santorum is the father of the health savings accounts countless Americans benefit daily from is as wrong as calling the sky green.”

Santorum is correct on his legislative record, but he did not “invent” HSAs. His name is not among the typical “Fathers” who are credited with the concept of MSAs and HSAs, and several experts we reached out to scratched their heads at his comment.

[Fact Checker: Santorum’s claim that all ‘net new jobs’ went to immigrants and fewer native-born Americans are working since 2000]

Health financing experts date the concept to the late 1970s. Three people are credited with introducing and popularizing the concept: American Medical Association’s former chief economist Jesse Hixson, National Center for Policy Analysis’s former president John Goodman, and Gerald Musgrave, senior fellow at NCPA, Dallas-based conservative think tank. (Goodman, most widely called “Father” of MSA and HSA, was known to give credit to Hixson, who first wrote about it.)

The Fact Checker’s review of legislative history found the Health Care Savings Account of 1985 was the only legislation predating Santorum’s that introduced a savings account for health-care expenses. This legislation contained many of the elements supported by proponents of HSAs. But it was geared toward senior citizens, allowing them to use the savings account after retirement before making Medicare claims.

In 1990, a task force of 40 think tanks, research groups and universities came up with a proposal. Patrick Rooney, former chairman of Golden Rule Insurance, was the first to offer MSAs to his employees. Goodman, Hixson, Musgrave and Rooney have all been called the “Father” of HSAs and MSAs. (This summary provides more details on the history of HSAs.)

Around 1993-94, MSAs became especially popular as a consumer-focused alternative to the Clinton administration’s ill-fated health-care proposal, which required employers to offer health insurance to employees. There were more than a dozen bills introduced as alternatives to what was seen by Republicans as a top-down approach to health care. (In 1994, Santorum introduced a bill with Republican Sen. Phil Gramm of Texas to allow employers to provide medical savings accounts.)

“It certainly wasn’t this case where Rick Santorum woke up with this idea, and put a bill in, and that’s how it came to life,” said Michael Tanner, senior fellow at the libertarian Cato Institute. “It had been going on 10, 20 years before that.”

MSAs were authorized in 1996 under the Health Insurance Portability and Accountability Act (HIPAA), which folded in several bills related to MSAs. The lawmaker whose name is most associated with MSAs is Rep. Bill Archer of Texas, then-chair of Ways and Means Committee who sponsored HIPAA. It gave small employers and self-employed individuals the option to create MSAs to reduce health insurance premiums and allow people to build a tax-free fund to pay for small medical expenses. These became known as “Archer MSAs.”

To the point about Gore, he never actually said he “invented” the Internet. The Fact Checker previously found that Gore used an awkward phrasing that he “took the initiative in creating the Internet,” to reference his work in Congress to advance funding for research to support creating the Internet. Then it was spun out of context, through media reports and other politicians, to the false claim now attributed to Gore.

[Fact Checker: A cautionary tale for politicians: Al Gore and the ‘invention’ of the Internet]

Santorum, not the economists, worked for 11 years in Congress to push HSAs and “is the legislator who got the health savings accounts passed,” according to Beynon. “To credit anyone else is like saying someone else deserves credit for a part of your college degree. You earned it. You deserve credit for it,” Beynon told us. “Same with health savings accounts and Rick Santorum.”

The Pinocchio Test

Santorum has been an outspoken supporter of medical and health savings accounts since 1992. He did, indeed, introduce the first legislation in 1992 that helped shape the modern-day HSAs. He deserves credit for pushing through legislation over 11 years.

But to claim he “invented” HSAs goes too far. Success has a thousand fathers, as they say, and Santorum is not the only one who can claim paternity of HSAs. It took more than a decade of research by a wide coalition of think tanks, economists, analysts and academics before it took off on Capitol Hill. Even there, Santorum was among many lawmakers who shepherded legislation to create what are now known as HSAs.

In 2013, The Fact Checker wrote that Gore deserved at least Two Pinocchios for his statement about “creating” the Internet. Had The Fact Checker existed in 1999, we would have made that ruling for the self-centered, exaggerated statement that obscured the fact that Gore passed legislation that helped foster the Internet. We will use the same standard we used for Gore. Santorum has a real story to tell about his achievements as a supporter of HSA. There is no need to go another step to exaggerate that he “invented” it.

Two Pinocchios


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Fact Checker: A cautionary tale for politicians: Al Gore and the ‘invention’ of the Internet

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