But a new study critical of HSAs raises another issue that employers must consider, and that is whether the high-deductible plans will fulfill the essential role of health insurance by keeping workers healthy and solvent in the face of high medical costs.
The study by the Commonwealth Fund, a New York-based think tank, shows that patients with deductibles of $500 or more are more likely to skip medical tests, treatment or follow-up exams or have prescriptions filled than insured adults with lower deductibles.
The survey, based on telephone interviews with a nationally representative sample of 4,052 adults ages 19 to 65, also showed that patients with deductibles of $500 or more had a greater tendency to run into serious financial difficulties. They were less likely to pay their medical bills and more likely to get contacted by a collection agency.
Commonwealth Fund president Karen Davis says health savings accounts and high-deductible plans have more downside than upside.
“Consumers may be spending less on frivolous things, but they also may be spending less on those things you really want people to have, like medication and treatment for things like congestive heart failure and high blood pressure,” she says.
Critics were quick to jump on the Commonwealth Fund research. HSAs have growing support, particularly in the health insurance industry. The savings plans are part of President Bush’s “ownership society” initiative and key to his efforts to reduce the number of Americans without health insurance.
Critics say the report is flawed because it was based on deductibles of $500 or more, well below the $1,000 for individuals and $2,000 for families mandated by the legislation setting up the health savings accounts. They also note that part of the survey was undertaken before HSAs began being offered last year.
Larry Akey, a spokesman for America’s Health Insurance Plans, an industry trade group, says, “It is difficult to see how the Commonwealth Fund can draw conclusions from data that predates HSAs.”
A key feature of HSAs is that money that is not used can accumulate in savings accounts. “We think HSAs are the answer to the problem Commonwealth raises, not the cause, because people will be able to set aside money to pay medical expenses,” Akey says.
Dan Perrin, executive director of the pro-high-deductible HSA Coalition, says HSAs “work for anyone hammered by health care costs, and that is everyone.”
Akey and Perrin say it is much too early to form conclusions about HSAs because they are so new. Davis agrees up to a point.
“If people are lucky and don’t get sick right away and build up five or 10 years of savings, maybe they will have enough to cover their needs,” she says. “We just don’t know.”