HSAs have gotten 400% more popular in the last decade. Insurers say the law hasn't kept up.

More U.S. residents are enrolling in health savings accounts (HSAs) coupled with a high-deductible health plan (HDHP), raising the need for policymakers to enact changes that better protect consumers from high costs and address their health care needs, according to a report released this month by America's Health Insurance Plans (AHIP), Politico's "Pulse" reports.

HSAs allow consumers to contribute pre-tax dollars to a personal savings account that can be used to pay for certain medical expenses. Under federal law, consumers are permitted to contribute up to $3,450 annually into an HSA for an individual and up to $6,850 annually into an HSA for a family. Consumers enrolled in HSAs-HDHPs are required to meet their health plans' full deductibles before the plans will cover most treatments and services.

Report details

The report is based on an annual survey of both AHIP member and non-member insurers from June 2017 through January 2018. Researchers then analyzed the survey data to examine:

  • Changes in enrollment between 2016 and 2017;
  • National trends in enrollment;
  • The distribution of enrollment by U.S. territory/state; and
  • The individual and group markets.

Findings

According to the report, enrollment in HSA-HDHPs increased by nearly 400% over a decade, from 4.5 million in 2007 to 21.8 million in 2017.

The researchers found that nearly 1.7 million more U.S. residents enrolled in HSA-HDHPs from January 2016 and January 2017, representing a nearly 8% increase in enrollment. According to the report, 45 health insurers that responded to both the 2017 survey and a similar survey AHIP conducted in 2016 saw a 9.2% increase in their HSA-HDHP enrollment.

In addition, the researchers found that:

  • 85% of respondents offered their members tools to manage their finances and health, such as online access to account information, cost and quality data, and health and wellness resources;
  • 64% of respondents provided their members access to broker consultations; and
  • About 60% of respondents hired health advocates to consult with their HSA members.

A call to action

The researchers said the rise in HSA-HDHP enrollment highlights a need for policy changes intended "to support good health and financial stability" among consumers.

For example, the researchers said Congress could approve:

  • The Chronic Disease Management Act, which would give insurers the flexibility to cover health care services and medication—such as insulin or inhalers—for enrollees with several chronic conditions before they meet their deductibles; and
  • The Bipartisan HSA Improvements Act, which, among other things, would expand the types of plans that are eligible for HSAs, raise HSA contribution limits, and allow insurers to cover more services pre-deductible.

Jeanette Thornton—SVP of product, employer, and commercial policy at AHIP—said, "The increase in popularity of these plans tells an important story about consumer-centric care." She added, "More than ever, patients want value from their coverage, choice in their health services, and control of dollars they spend on care" (Stankiewicz, FierceHealthcare, 4/13; Diamond, "Pulse," Politico, 4/13; Morse, Healthcare Finance News, 4/16; AHIP release, 4/12; AHIP report, April 2018).

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