Podcast Summary: Bloomberg Businessweek – "The Cost of Your Health"

Date: September 9, 2025
Hosts: Carol Massar, Tim Stenovec
Guest: Scott Cutler, President & CEO of HealthEquity

Episode Overview

This episode of Bloomberg Businessweek explores the rising costs of health care in the United States and the role of Health Savings Accounts (HSAs) in addressing both employee and employer needs. Scott Cutler, CEO of HealthEquity, joins the hosts to discuss recent company performance, the growing importance of HSAs, impacts of legislative changes, and broader trends underlying health care affordability.

Key Discussion Points & Insights

1. HealthEquity’s Business Model & Reach

• Market Presence:

  • HealthEquity administers HSAs, FSAs, and other reimbursement accounts for about a quarter of working Americans ([02:30]).
  • Market cap stands at $8.4 billion.

• How the Company Makes Money:

  • Primarily through fees and services tied to managing these accounts.
  • HSAs are described as the most tax-advantaged savings vehicles available: “You should be contributing at the max…you can have it grow tax free and ultimately you can spend it tax free for healthcare related expenditures.” – Scott Cutler ([02:42]).

2. HSAs vs. FSAs: Key Differences

• HSAs:

  • Not "use it or lose it." Funds roll over and can accumulate.
  • Require a high-deductible health plan (HDHP) ([03:29]).
  • Annual family contribution limit is about $8,500 as of 2025.
  • Both a savings and investment tool for future healthcare needs.

• FSAs:

  • Generally "use it or lose it."
  • More narrowly tied to active employment and immediate spending.

3. Eligibility and Recent Legislative Changes

• Expansion Under Recent Legislation:
  • Eligibility now extends to those enrolled in ACA Marketplace bronze plans ([05:34]).
  • “We’re bringing in the largest expansion of the HSA eligibility in the last 20 years.” – Scott Cutler ([05:34]).
  • Telehealth services are now HSA-eligible under the Trump administration’s changes.

4. Employer and Employee Perspectives

• Employer Side:

  • Employers offer HDHPs with HSAs to manage soaring healthcare costs:
    • “Healthcare costs are growing at three times that of wages.” – Scott Cutler ([04:34]).
  • Some, like HealthEquity itself, offer only high-deductible health plans, then match and contribute to employees’ HSAs.

• Employee Side:

  • Employees must actively choose HDHPs to participate in an HSA.
  • Education gap remains: not all employees understand the benefits or mechanics ([04:14]).

5. Healthcare Affordability Crisis

• Cost Pressures:
  • Health care remains unaffordable for many individuals and even employers ([06:30]).
  • HSAs are positioned as a tool to prepare for current and future healthcare expenses.

6. Insights into the Labor Market

• Connection to Job Market Trends:
  • Early 2025: weaker job market, less churn.
  • Employers and employees both feeling pressures—less hiring, heightened concern about healthcare costs ([06:30]).

7. User Demographics & Use Cases

• Demographics:

  • HSA users are “as broad as the US workforce would be. Old, young, old.” – Scott Cutler ([07:20]).
  • Increasingly integrated with digital apps and wellness behaviors.

• Other Benefits:

  • HealthEquity also administers commuter, dependent care, and lifestyle reimbursement accounts, but the majority of business is in HSAs ([08:23]).

8. Macroeconomic & Regulatory Environment

• Legislation’s Fast Pace and Uncertainty:

  • “The regulatory front creates a lot of uncertainty…You have to decide where you want to take risk, what you can control and manage.” – Scott Cutler ([09:10]).
  • Expiring tax credits in health care are a significant concern for the coming year.

• Lobbying & Policy Advocacy:

  • HealthEquity actively lobbies for broader HSA access and greater healthcare cost affordability ([10:04]):
    • “Our agenda has really been: how do you address the affordability crisis of health care and how do you prepare more Americans for that health care expense?”

Notable Quotes & Memorable Moments

“A little known fact about Health Savings Accounts is that they are the most tax advantaged savings vehicle.”
— Scott Cutler ([02:30])

“It's always associated with a [high deductible] plan… only about a third of people, when offered the choice, will select a high deductible health plan. But in reality, [out-of-pocket costs] are typically no more expensive…particularly when you combine it with an HSA.”
— Scott Cutler ([03:29])

“We have a whole new class of Americans now qualified to be able to… enroll in an HSA. We’re bringing in the largest expansion of HSA eligibility in the last 20 years.”
— Scott Cutler ([05:34])

“Healthcare costs are growing at three times that of wages.”
— Scott Cutler ([04:34])

“Health care is unaffordable for many people and companies. We have visibility into both of those trends.”
— Scott Cutler ([06:30])

“The regulatory front creates a lot of uncertainty around what’s going to happen… as a leader, you have to decide where you want to take risk, what you can control and manage.”
— Scott Cutler ([09:10])

“Our agenda has really been: how do you address the affordability crisis of health care and how do you prepare more Americans for that health care expense?”
— Scott Cutler ([10:04])

Timestamps for Important Segments

• [02:30] – Scott Cutler explains HealthEquity’s core business and HSA mechanics.
• [03:29] – Breakdown of differences between HSAs and FSAs; prerequisites for HSA participation.
• [05:34] – Legislative changes expanding HSA eligibility.
• [06:09] – Labor market signals from HealthEquity’s customer base.
• [07:20] – Demographics and stories from HSA users.
• [08:23] – Other reimbursement and commuter benefits handled by HealthEquity.
• [09:10] – Macro and regulatory risks, and company reaction.
• [10:04] – HealthEquity’s lobbying agenda and its impact on the US healthcare system.

Conclusion

This episode dives into the complexities of health care costs, policy changes, and the importance of HSAs as both a savings vehicle and a tool for financial health. Scott Cutler highlights how both individuals and corporations are grappling with rising expenses, expanding eligibility, and the growing need for education around healthcare planning. HealthEquity’s position at the center of these trends offers a unique insight into the American healthcare economy’s evolving landscape.