There was a great deal of uncertainty in the health care industry last year, in light of the COVID-19 crisis. But a new report from Lively finds that one thing didn’t change—health care costs continued to rise.

According to the report, between 2019 and 2020, the average annual premium for single and family coverage increased by 4%, and, as in past years, premium health care costs continued to rise at a faster pace than the annual rate of inflation.

2021 health insurance premium costs were also expected to be volatile, according to the report.

The high cost of health care in the U.S. has led many financial experts to worry about how it is affecting long-term savings. Health savings accounts (HSAs) are an optimal vehicle to save for health care costs in the short-term and in retirement, yet higher health costs in the U.S. force many people to spend the money in their HSA accounts—not save it—and can put retirees futures at a risk.

“HSAs are a great complement to 401(k) accounts when directly saving for health care costs in retirement. But, unfortunately, HSAs aren’t enough. COVID-19 has worsened the retirement gap. It’s forced many Americans to withdraw or borrow money from their 401(k)s in 2020, putting them even further behind,” says Shobin Uralil, chief operating officer (COO) and co-founder of Lively, in an interview with PLANSPONSOR. “Retirement is too often an afterthought. Even people who have HSAs spend the majority of their funds on yearly health care costs, draining their accounts and locking themselves out of full savings potential.”

Due to rising health care costs, Lively expects more employers to offer high-deductible health plans (HDHPs) and more employees to enroll in them. Even before the coronavirus crisis, HDHP enrollment saw large increases. Between 2007 and 2018, the percentage of those who had private health insurance, were under age 65 and were enrolled in an HDHP rose from 17.4% to 46%.

Some are hoping Congress will expand HSA availability to plans outside of HDHPs. Sean Engelking, founder and CEO of Starship, a venture-backed HSA startup in New York City, who has represented the HSA Council before Congress, the White House and the U.S. courts, believes HSA access should be expanded nationwide.

“Part of the issue is having an HSA tied to employment and having a high-deductible health plan,” Engelking tells PLANSPONSOR. “Everything is a high-deductible plan, basically, if you look at the national numbers about health plan deductibles.”

“Why wouldn’t we try to do something about the crisis [regarding the cost of] health care?,” he continues. “It shouldn’t matter how or whether people work, they should be able to have HSAs. We are essentially asking Congress to decide that if someone has insurance,” any Patient Protection and Affordable Care Act (ACA) plan, “they can have an HSA.”

As vaccinations become more available to more people in the future, Lively foresees those costs, along with those associated with COVID-19 testing, to factor into higher health care rates in 2021. The firm also expects that people will reschedule medical services and procedures they put off last year amid the pandemic, which could drive up costs.