Cath Lab Digest

Increases in Enrollment and Assets Continue

Led by growth among large-group insurers, enrollment in high-deductible health plans (HDHPs) and associated health savings accounts (HSAs) exceeded 10 million this year. Separate research projects recently conducted by America’s Health Insurance Plans (AHIP) and the Employee Benefit Research Institute (EBRI) quantify expansion in both the number and value of HSAs. After several years of increases, the continued expansion of HDHP/HSA arrangements may depend on how new regulations issuing from national healthcare reforms influence the type of insurance consumers choose to purchase.

HSAs were first introduced in 2004 after passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003, but according to the EBRI, account-based health plans were first offered by employers in 2001 as health reimbursement arrangements (HRAs), a type of employer-funded health plan that reimburses workers for qualified medical expenses. Consumer-driven health plans (CDHPs) allow enrollees to use HRAs, HSAs, or similar accounts and are offered by most insurance companies.

HSAs were designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis. These accounts are owned by an individual and are used to pay for current and future medical expenses. The accounts can also be used to mitigate the tax burden on individuals who choose to use HSAs to save for health expenses after retirement.

AHIP Census
AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market since 2004, and this year almost all plans in the United States that sell HSA/HDHP products in the United States participated. AHIP’s 2010 census gathered data from 93 insurance companies. The census was compiled by Hannah Yoo of AHIP’s Center for Policy and Research.

“HSA plans continue to be an important coverage option for families and small businesses across the country,” said Karen Ignagni, president and CEO of AHIP.
The census found that as of January 2010, the number of people covered by HSA/HDHP products increased by 25% compared with last year, to about 10 million. A higher percentage of the accounts were held by men (52%) than by women (48%). Growth was fastest in the large-group coverage market, at 33%, and in the small-group market, at 22%. The number of people with HSA/HDHP coverage was 8 million in January 2009 and 6.1 million in January 2008.

In the individual market, 2.1 million people had HSA/HDP coverage in January 2010 compared with 1.8 million in January 2009. More than half of these enrollees (52% including dependents covered under family plans) were aged ≥40 years.
EBRI Survey

Coinciding with increases in HDHP/HSA enrollment, assets in HSAs and HRAs have grown in recent years and totaled $7.1 billion in 2009, up from $835.4 million 3 years earlier, according to survey results published by EBRI. The study, based on findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey, was published in the June 2010 EBRI Issue Brief and examines HSA and HRA assets, account balances, and rollovers from 2006 to 2009. The brief was prepared by Paul Fronstin, director, Health Research and Education Program, EBRI.

The EBRI/MGA Consumer Engagement in Health Care Survey is an online survey of privately insured adults aged 21 to 64 years that is conducted via the Internet. The survey found that in 2009, 4% of the population was enrolled in a CDHP, up from 3% in 2008. Enrollment in HDHPs increased from 11% in 2008 to 13% in 2009. Among the 16.2 million individuals with an HDHP, 38% said they were eligible for an HSA but did not have one.