In my experience the cost of a low deductible health plan is more expensive than a high deductible health plan + equivalent amount of a pre tax HSA.
I have never known a health care provider that you can’t negotiate a payment plan with. Even if your HSA isn’t funded, they could probably have a payment plan = HSA monthly contribution and then take it out of the HSA.
Yes I understand that a lot of people making $40K would be deftly afraid of doing that. But they would still statistically come out ahead
A family making 40k a year qualifies for significant benefits and subsidies, even today. But don't let not knowing what you're talking about stop you from angrily talking about it.
The difference being that if you don’t need to use your HSA in a year you keep it - unlike low deductible plans.