Have HSAs been a success?

For people who have them, yes they are often a success and do what they were intended to do. Many people love this new program.

But not as many people have signed up for HSAs as originally planned. The boosters had bigger hopes and some are wondering why the accounts are not more popular.

Part of it could be inertia. People are used to conventional health insurance plans, and they find these new plans confusing. Nobody they know has them, so they regard HSAs as something for other people, not people like them. Also, in the years following the introduction of HSAs, there was a national debate about health care financing, which resulted in the 2010 passage of the Affordable Care Act. This new system was confusing for many, and HSAs, got lost in the shuffle.

Another reason is that people don’t like to think like consumers when faced with medical decisions. They want more of a paternalistic system in this area of their lives, and insurance companies, no matter how people like to complain about them, offer them such a system. Health concerns can be scary.

Here’s a summary of an early study done on consumer satisfaction with HSAs:

http://www.ebri.org/publications/ib/index.cfm?fa=ibDisp&content_id=3606

A paper by two members of the Wake Forest University Medical School points out that HSAs and managed care can be integrated so as to point out payment responsibilities of the insured and the insurers.