Health savings accounts: Early estimates of national take-up. Various subsidies to help people open health savings accounts could greatly reduce the number of uninsured Americans

Health Affairs

Volumn 24, Issue 6, 2005, Pages 1582-1591

  Feldman, Roger ^a,b   Parente, Stephen T ^a,c   Abraham, Jean ^a,d   Christianson, Jon B ^a,d   Taylor, Ruth ^a,e  

^a UNIVERSITY OF MINNESOTA   (United States)

^b School Public Health   (United States)

^c UNIVERSITY OF MINNESOTA   (United States)

^d School of Nursing and Mailman

^e Carlson School   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CONSUMER; COST; ECONOMICS; HEALTH INSURANCE; HUMAN; LEGAL ASPECT; MEDICARE; MIDDLE AGED; PATIENT; UNITED STATES; UTILIZATION REVIEW;

ADULT; CONSUMER PARTICIPATION; HEALTH BENEFIT PLANS, EMPLOYEE; HUMANS; MEDICAL SAVINGS ACCOUNTS; MEDICALLY UNINSURED; MEDICARE; MIDDLE AGED; UNITED STATES;

EID: 28444496674     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.24.6.1582     Document Type: Article

References (21)

1. J.B. Christianson, S.T. Parente, and R. Taylor, "Defined- Contribution Health Insurance Products: Development and Prospects," Health Affairs 21, no. 1 (2002): 49-64.
2. Mercer Human Resources Consulting, "U.S. Health Benefit Cost Rises 7.5 Percent in 2004, Lowest Increase in Five Years," Press Release, 22 November 2004.
3. S.T. Parente, R. Feldman, and J.B. Christianson, "Evaluation of the Effect of a Consumer-Driven Health Plan on Medical Care Expenditures and Utilization," Health Services Research 39, no. 4, Part 2 (2004): 1189-1210.
4. R. Kazel, "Blues Pledge Nationwide Expansion of HSAs," American Medical News, 13 December 2004.
5. U.S. Department of the Treasury, General Explanations of the Administration's Fiscal Year 2005 Revenue Proposals (Washington: U.S. Treasury, February 2004).
6. W.S. Custer, C.N. Kahn III, and T.F. Wildsmith IV, "Why We Should Keep the Employment-based Health Insurance System," Health Affairs 18, no. 6 (1999): 115-123.
7. M. Pauly A. Percy, and B. Herring, "Individual versus Job-based Health Insurance: Weighing the Pros and Cons," Health Affairs 18, no. 6 (1999): 28-44.
8. One employer is located primarily in Minneapolis; the other employers' establishments are dispersed widely throughout the United States.
9. T.D. Musco and T.F. Wildsmith, "Individual Health Insurance: Access and Affordability," Brief Analysis (Washington: Health Insurance Association of America, October 2002);
10. and T.F. Wildsmith, Individual Health Insurance: Wide Choice of Benefits Available (Washington: America's Health Insurance Plans, 2004).
11. S.T. Parente, R. Feldman, and J.B. Christianson, "Employee Choice of Consumer-Driven Health Insurance in a Multiplan, Multiproduct Setting," Health Services Research 39, no. 4, Part 2 (2004): 1091-1112.
12. We wanted to include employee (or family) health status in the choice model, but, unfortunately, we did not have these data. However, in our previous work (see Note 10), we found that health status was not a significant predictor of enrollment in a consumer-directed plan. Therefore, we do not believe that this is a serious omission.
13. Because state identification codes are not available in the MEPS-HC data, we could not adjust the out-of-pocket premium by the employee's state income tax rate if applicable.
14. Mercer, "U.S. Health Benefit Cost."
15. The most likely bias from this approach is that we will underestimate the attractiveness of an HSA, which features employee "ownership" of the account.
16. Additional details about the HSA policies used in the simulations are available from the authors. Contact Roger Feldman, feldm002@umn.edu.
17. We do not attempt to predict the ultimate insurance choices of workers who turn down an employer offer but do not buy an individual HSA. Some will obtain insurance through a spouse's policy, but others will remain uninsured.
18. Under the administration's proposal, the tax credit would apply only to the insurance premium, not to the HSA account. However, MMA lets consumers fund their accounts with pretax dollars, and this subsidy would stay in place.
19. These subsidies applied both to single people with no dependents and to families. We did not attempt to "spline" the subsidies as in the administration's proposal.
20. The $211 billion for the full subsidy of a generous HSA was derived by adding the subsidy in the individual market ($98.7 billion) to the subsidy for those who turn down employer coverage ($122.4 billion).
21. The subsidy claimed by those already insured could be viewed as a reward for "doing the right thing."