Growth in HSA plan enrollment slows

Many Republicans, including President Donald Trump, say they want to replace the Affordable Care Act health insurance system with a new system that will rely more heavily on health savings accounts.

In 2016, however, with the ACA system still in effect, health insurers had a hard time increasing sales of HSA-compatible coverage.

Analysts at America's Health Insurance Plans have published data on the state of the market for HSA-compatible coverage in a new survey report.

The participating carriers said they covered 20.2 million U.S. residents through HSA-compatible, individual, small-group or large-group plans in 2016.

The number of people with HSA-compatible coverage was just 2.4 percent higher than in 2015.

Between 2014 and 2015, enrollment in HSA-compatible coverage grew 3.6 percent.

AHIP also reported data implying that the number of insurers in the HSA-compatible plan market might be falling.

The Washington-based trade group has recorded a drop in the number of issuers participating in its survey every year from 2012 through 2015. The number dropped again in 2016. Just 59 issuers filled out survey forms for 2016. The issuer count was down 7.8 percent, from 64, in 2015. In 2012, 95 issuers filled out survey forms.

AHIP believes that a total of 97 issuers were selling HSA-compatible coverage in 2016. The number of known HSA plan issuers was down from 109 in 2015, and down from 113 in 2014.

An AHIP representative said the organization believes the decline in the number of survey participants is mainly a result of survey participation issues and does not reflect a decline in insurer activity in the HSA-compatible plan market.

In 2017, the top annual out-of-pocket spending maximum for an individual account holder is $6,550. (Image: Thinkstock)

In 2017, the top annual out-of-pocket spending maximum for an individual account holder is $6,550. (Image: iStock)

More AHIP HSA data

In other survey results, AHIP found that:

- - - Only 1.9 million of the HSA-compatible coverage users had individual or family policies.
    - Only 11 percent of the enrollees in HSA-compatible coverage are in the 25-44 age group, and 35 percent are in the 45-64 age group.
    - Seventy-five percent of the participating insurers provide some kind of health care cost information online.

To be compatible with the HSA program, health coverage must make the patient responsible for a lot of medical bills, but not too much. For an individual in 2017, the minimum deductible is $1,300. But the top amount an HSA-compatible plan can require a patient to spend on in-network, covered care is $6,550.

The Affordable Care Act major medical rule architects and implementers had mixed feelings about use of HSAs and high-deductible coverage. Some liked the idea of using relatively high out-of-pocket spending requirements to give patients "skin in the game," and encourage patients to hold down spending. Other Democrats suggested that high out-of-pocket spending costs might hurt patients' access to care.

Top Trump administration health agency officials have expressed similar mixed feelings about high-deductible health coverage.

Trump included the idea of expanding the HSA program as a major part of his health policy proposal package when he was running for president.

Dr. Tom Price, Trump's new Health and Human Services secretary, frequently called for expanding the HSA program when he was serving the House. But Price, an orthopedic surgeon, said during a Senate confirmation hearing that he believes high deductibles are keeping some patients from getting the care they really need.

For insurers operating under Affordable Care Act individual major medical rules, one problem is that the rules have pushed the deductibles for the cheapest individual major medical policies over $6,000. In some markets, the deductibles for the cheapest individual policies are too high for the policies to be HSA-compatible.

Correction: An earlier version of this story described AHIP's interpretation of its HSA-compatible plan activity data incorrectly. AHIP analysts believe the drop in the number of participating insurers is the result of a survey response issue, not a drop in insurer activity in the HSA-compatible plan market.

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