Health Savings Accounts Popular, But Not Universally Available
The majority of consumers who have signed up for tax-advantaged Health Savings Accounts (HSAs) are satisfied with their health care coverage, according to a survey by the Blue Cross and Blue Shield Association (BCBSA). But a recently published study by the Galen Institute found that, nearly two years after HSAs first became available, many states still have legal barriers to the efficient delivery of HSA plans in place.
BCBSA conducted an online survey of 3,000 consumers enrolled in both consumer-driven health plans (CDHPs) and conventional plans. Among the HSA-eligible enrollees responding to the survey, 68% indicated they are satisfied with the performance of their insurer, 71% said they are satisfied with their access to preventive care and wellness services, and 69% said they are satisfied with the health benefits information provided by their insurer. These satisfaction levels compared favorably with those of enrollees in traditional insurance plans, according to BCBSA researchers.
The survey also showed that 65% of the HSA-eligible enrollees who purchased their coverage directly and 61% of those who obtained coverage through their employers would recommend CDHPs to others.
The age and health status of the HSA-eligible enrollees who participated in the survey did not differ significantly from that of enrollees in traditional insurance products, researchers noted. The two groups were also found to be equally likely to request generic drugs, choose not to go to a doctor, delay seeing a doctor or having a medical procedure, delay or fail to fill a prescription, and take a lower than recommended dose of a prescribed drug.
The HSA-eligible enrollees were, however, found to be twice as likely as participants in traditional plans to have been previously uninsured. Results further showed that HSA-eligible enrollees were more likely than traditional plan enrollees to make use of information and services provided by the insurer, such as drug price comparisons, cost-tracking tools, and online wellness programs.
"The success of HSAs and other consumer-directed health plans is predicated on consumers pursuing information and applying that knowledge to their health care decisions. The survey shows that consumers enrolled in HSAs are beginning to do just that," said Maureen Sullivan, senior vice president, Strategic Services, BCBSA.
Growing numbers of businesses are interested in offering HSAs coupled with high-deductible plans to their employees, but state regulations often get in the way, David Hogberg concluded in the Galen Institute report "HSAs and the States: Lifting the Barriers."
While most states have changed their income tax codes to accommodate HSAs, eight states—including California, New Jersey, Wisconsin, and Pennsylvania—continue to tax contributions, according to the report. "There is little excuse for the delay," Hogberg said, observing that changing a tax code is relatively easy to do and that the eight states currently taxing HSA contributions can afford the exemptions.
Another barrier to HSA take-up in many states, the report said, are first-dollar coverage mandates, which require insurance to cover certain conditions and treatments from the "first dollar," before any deductible is met. Because most non-preventive care mandates conflict with the IRS regulations governing HSAs, Hogberg said, states will be required to eliminate some types of first-dollar coverage mandates by the end of this year. Hogberg called upon states to repeal these mandates or, barring that, exempt HSA qualifying insurance from such mandates.
A further problem for HSA providers are the community rating regulations of 27 states and the guaranteed issue regulations of 5 states, the report said. The community rating process, which averages all the premiums in a given region when setting premiums for individuals, discourages healthy people from buying health insurance, according to Hogberg. Guaranteed issue rules, which stipulate that an insurance company may not refuse coverage to individuals with health problems, tend to limit the number of insurance providers willing to offer individual policies. The report noted that HSAs are not available at all in any of the five states with guaranteed issue rules. Hogberg recommended eliminating these regulations or creating exceptions for HSA plans.
An additional obstacle faced by insurance providers in most states is the need to seek approval of the state department of insurance before selling a policy. While some of these processes are relatively simple, the report said, they can be more complex in the case of HSAs because many companies are still developing their policies. To avert delays in providing coverage, Hogberg advised, states should streamline their procedures, and state legislatures should pass laws allowing insurance providers to start selling a policy if the department of insurance fails to either approve or deny it within 60 days.
