The theory behind high-deductible health plans was that making consumers more aware of the cost of health care would make them better and more cautious consumers, and this would ultimately slow down spending growth, as fewer inappropriate or low-value services were received and lower-priced providers were sought out. Supposedly premiums for these plans would be lower than for comparable ones without high deductibles, but consumers’ share of premiums has also been rising. And in addition to larger deductibles, covered persons also have other forms of increased cost-sharing, including higher copays and co-insurance. One offset to this higher premium and cost-sharing was supposed to be the use of health savings accounts, to which both an employer and an employee could contribute and which could be used for various health expenses and could be carried over from year-to-year. But recent research from the Employee Benefits Research Institute indicates that contributions to HSAs are dropping, even as cost-sharing grows. (EBRI Notes) About 15% of the population, or 26 million persons, was in a high-deductible plan in 2014. Only 57% of these even opened an HSA or an HRA, another form of tax-free reimbursement for health costs. Among employees with access to an HRA or HSA, 67% said the employer contributed to it, a slight decline from 71% in 2013.
In recent years, the amount being contributed has also fallen. Between 2011 and 2014, the number of employees with individual coverage contributing nothing to their HSA rose from 11% to 23% and the number contributing $1500 or more fell from 44% to 30%. For family coverage, the percent not contributing was 14% in 2007, 6% in 2013 and 8% in 2014. The percent contributing at least $1500 went from 50% in 2011 to 59% in 2012 and now to 54% in 2014. This during the economic recovery. Meantime, employer contributions have fluctuated, with 24% of employees with individual coverage saying their employer contributed at least $1000 to the HRA or HSA in 2011, to 28% in 2012, to 23% in 2013 and most recently 34% in 2014. The figures are higher for family coverage with 59% of firms contributing at least $1000 in 2013 but only 51% in 2014. One ameliorating factor may be that those not contributing or contributing less tend to have had an HSA for longer, so they may have a balance built-up and feel less immediate pressure to add to it. Unfortunately, but as might also be expected, lower-income employees are less likely to contribute at all and to contribute less when they do. Individuals who were more engaged with their health and health care by a number of measures were also more likely to contribute or contribute more. The sad overall conclusion appears to be that those who likely are already most financially stressed by health care needs are the least likely to create a cushion against some of those costs.