How HSA Expansion Fueled One Insider’s Wellness Empire

By VirentaNews Staff — April 27, 2026

In 2023, health savings accounts (HSAs) saw a surge in growth, with over $120 billion in assets held across more than 37 million accounts, according to the Employee Benefit Research Institute. This expansion was fueled in part by policy changes advanced during the final years of the Trump administration, which sought to broaden HSA eligibility and usage. Behind the scenes, Calley Means, a senior health policy adviser to Robert F. Kennedy Jr., remained president of the wellness company TrueMed — a firm built entirely on facilitating HSA and flexible spending account (FSA) purchases for supplements and wellness products. With TrueMed generating an estimated $50 million in annual revenue, the dual role raises pressing questions about conflict of interest, regulatory influence, and the blurring line between public service and private gain in U.S. health policy.

The Rise of Health Savings Accounts Under Trump

Health savings accounts, first introduced in 2003, allow individuals with high-deductible health plans to set aside pre-tax dollars for medical expenses. Under the Trump administration, HSAs became a cornerstone of conservative health care reform, promoted as tools to empower consumers and reduce reliance on traditional insurance. The administration advanced multiple regulatory changes, including a 2020 rule under the Department of Health and Human Services that expanded the list of HSA-eligible items to include over-the-counter medications without requiring a prescription. This shift was a windfall for the wellness industry, instantly broadening the market for vitamins, pain relievers, and dietary supplements. The move aligned closely with long-standing industry lobbying efforts, and TrueMed, which operates a digital platform verifying HSA/FSA eligibility for thousands of wellness products, stood to benefit directly.

Calley Means: Policy Adviser and Wellness Executive

Calley Means served as deputy director of public engagement in the Trump administration’s HHS from 2017 to 2018 before becoming a senior adviser to Robert F. Kennedy Jr. during his 2024 presidential campaign, where he shaped the candidate’s health care platform. Yet throughout this period, Means remained president of TrueMed, a company he co-founded in 2018. TrueMed’s business model depends on the expansion of tax-advantaged accounts: it partners with retailers, supplement brands, and benefits platforms to ensure products are coded as HSA-eligible and seamlessly purchasable. In interviews, Means has defended the arrangement, stating that TrueMed’s mission is to “democratize access to health” and that his policy work focused on transparency and patient empowerment. However, ethics experts note that holding a leadership role in a company profiting from policy decisions one helps shape presents a clear conflict, even if no formal rules were violated.

Policy and Profit: The Mechanics of Influence

The 2020 OTC expansion was not an isolated event but part of a broader ideological push to shift health care spending toward consumer-directed accounts. Means was an outspoken advocate for this approach, publishing op-eds and participating in policy forums promoting HSA growth. While he was not a formal decision-maker in the final rulemaking, his proximity to key officials and his active role in shaping the narrative around HSA utility provided indirect influence. According to federal ethics guidelines, former officials are generally restricted from lobbying their former agencies for one year, but there are no rules preventing them from running private businesses that benefit from broad regulatory changes. TrueMed’s timing was strategic: launched shortly after Means left government, the company positioned itself as a bridge between the evolving regulatory landscape and the $50 billion dietary supplement market. The result was a business model perfectly aligned with — and enriched by — federal policy.

Implications for Health Policy and Public Trust

The convergence of policy advocacy and private enterprise in the HSA space underscores a broader trend in U.S. health care: the increasing role of market-based solutions in public health. While expanding HSA eligibility offers convenience for consumers, critics argue it disproportionately benefits higher-income individuals who can afford to contribute more to these accounts. Moreover, allowing tax-free spending on supplements — many of which lack robust clinical evidence — risks subsidizing an industry with minimal oversight. For public health advocates, the Means case highlights how policy can be shaped by insiders with financial stakes, potentially skewing priorities away from preventive care and toward commercial interests. As HSA-eligible spending on supplements grows, so too does scrutiny over whether such policies serve public health or private profit.

Expert Perspectives

“This is the epitome of regulatory capture by stealth,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School and expert on health policy ethics. “When former officials profit from rules they helped promote, it erodes trust in the impartiality of the system.” In contrast, health care economist Avik Roy, a supporter of consumer-directed health care, argued that Means’ work exemplifies public-private collaboration. “If a private company can make health spending more efficient, that’s a win for everyone,” Roy said in a Forbes commentary. Still, even supporters acknowledge the need for clearer ethics boundaries as the line between policymaking and entrepreneurship blurs.

As Robert F. Kennedy Jr. continues to campaign on a platform of health freedom and transparency, scrutiny over his advisers’ past roles will likely intensify. The broader question remains: how can the U.S. ensure that health policy serves the public interest when key architects stand to gain financially? With HSAs projected to surpass $150 billion in assets by 2026, according to EBRI research, the intersection of policy, profit, and wellness is only set to grow — and demand closer oversight.

Source: The New York Times