Health savings accounts as proposed in President Bush's healthcare plan would likely expand coverage to less than 1 million of the nation's 45 million uninsured and could destabilize the group market for small employers, according to a study released last week by the Commonwealth Fund.
Separately, two major hospital industry groups said their survey of large insurers indicated that a competitive market was evolving for HSAs and similar Health Reimbursement Arrangements, with most of such products on the market offering access to hospitals and physicians that is comparable to insurers' other plans.
According to the Commonwealth Fund study, the tax incentives meant to promote HSAs would be of little benefit to the uninsured. More than half of uninsured adults owe no income taxes, while for middle-income uninsured individuals, tax incentives would offset just 3% to 6% of a typical high-deductible plan's annual $2,000 premium. Consequently, 100,000 to 900,000 uninsured adults - 0.3% to 2% of the adult uninsured population -would adopt HSAs, the study estimated. A companion study found that for individuals with annual incomes of up to 200% of the federal poverty level, premiums for a high-deductible plan would take 6% to 30% of their incomes and accompanying out-of-pocket costs would consume up to 30% more. Two-thirds of the uninsured have incomes below the federal poverty level.
Meanwhile, the American Hospital Association and the Federation of American Hospitals said most HSAs and HRAs, representing 95% of current enrollment in such plans, build on the insurers' existing provider networks and contracted rates. About 60% of health plans provide comparative cost information for consumers, and of those, about half provide average costs for specific services across the HSA/HRA market, the survey found. Nearly half of HSAs and HRAs publish quality data, with 40% providing information about hospitals.