HSA and CDHP Growth

The idea behind the “consumer-driven” high deductible health plan was that patients would be more attentive to their health and health care needs if they were spending more of their own money on health.  It is hard to believe, however, that much of these plans growth is not due to the savings they create for employers.  Regardless of the reason, they have shown strong increases in enrollment since their inception.  America’s Health Insurance Plans releases an annual census of enrollment, created by surveying most insurers offering such plans.    (AHIP Survey)   The plans are frequently accompanied by a health savings account, in which the employer and/or individual places funds, which can be rolled over to future years, if not used in the current plan year.  As of January 2014, 17.4 million Americans were enrolled in CDHP coupled with an HSA.  For the last four years, about 2 million people a year have been added to this type of insurance.  About three-quarters of these people are enrolled through large group policies (more than 50 employees), about 14% through small group and 11% through individual health insurance purchases.  The individual market splits evenly between male and female enrollees and is also evenly divided between those age 40 or over and those under 40.  While the large group market has gained enrollment rapidly, the small group market has lost CDHP/HSA members, likely due to people going to the exchanges.

Most of these plans offer a variety of tools to help patients become more informed and be actively involved in health care decisions.  Ninety-one percent have health education information available; 88% general information about doctors; 66% cost information; 57% physician-specific quality data; 70% hospital-specific quality data; 84% have information on the member’s HSA and 75% include the ability to create a personal health record.  Largest number of enrollees are in the states of Texas, Illinois, Ohio, Pennsylvania and Michigan and the highest percent of all insureds being in a CDHP/HSA in Minnesota, Illinois and Washington.  In addition to the CDHP/HSA, a number of other persons have a CDHP with an HRA and many are in high-deductible plans with no kind of savings account attached.  We should anticipate that eventually these plans will constitute the majority of the market, particularly among non-unionized, private employers, but governments and unions will get there eventually as well.  They have shown some ability to reduce spending, with so far limited negative effects on accessing needed care.