Tim Hayes
Contributing Writer
PA Manufacturer Magazine
The first thing most people associate with the Medicare Modernization Act is the prescription drug benefit for seniors, but another provision in that legislation is proving to be more popular and easier to understand and use – Healthcare Savings Accounts, or HSAs.
Under an HSA, interest-bearing tax-free accounts can be opened by anyone who purchases a low-premium, high-deductible insurance policy. The insurance policy itself covers unseen medical catastrophes. Meanwhile, the money put into the HSA account can be used for routine health expenses – from contact lenses to office visits – with unused savings accruing from year to year.
HSAs put healthcare choices back into the hands of consumers. What’s more, they’re designed to lower the cost of insurance for many Americans who otherwise could not afford medical coverage. The basic idea is to give individuals a tax break while deregulating the market for health insurance.
A new type of coverage
While the marketing appeal of HSAs remains strong, acceptance has been spotty across Pennsylvania, lagging behind adoption of the new plans nationally.
At least 3 million American consumers currently receive health coverage through high-deductible health insurance plans offered in conjunction with HSAs, according to preliminary results of a recent study by America’s Health Insurance Plans (AHIP). According to the study, enrollment in the new insurance policies eligible for HSAs has roughly tripled since March 2005, when a similar AHIP survey found that slightly more than 1 million people were similarly covered.
The study was based on aggregated responses from AHIP member companies, which represent nearly all the health insurance plans offering HSA-eligible options. The preliminary findings also show that the market for HSAs is becoming broader, with companies offering HSAs in more markets and to a wider array of large group, small group and individual customers.
“HSAs are one of the most important innovations in the history of American healthcare,” asserted Sally C. Pipes, President and CEO of the Pacific Research Institute. “Indeed, they have the potential to eliminate the uninsured crisis while drastically cutting medical costs and improving service.
“About 40 percent of plans are being purchased by individuals who were previously uninsured,” said Pipes. “And while early critics worried that HSAs would be used only by the young, healthy or well-to-do, the numbers don’t bear out these fears. About half of HSA buyers are over 40; a fifth are over 50. Twenty-nine percent of account holders earn less than $50,000 a year. Evidence suggests many new HSA buyers have chronic health troubles.”
A slow start
“Acceptance and implementation of HSAs is going slowly in Pennsylvania because of the dominance of the Blues,” noted David E. Edman, Managing Partner of Risk Management Partners LLC, an insurance consulting firm in suburban Philadelphia, referring to the traditional healthcare insurers like Blue Cross and Blue Shield. “The Medicare drug bill held a hidden gem, enabling creation of HSAs because they put individuals in charge of their own cost containment, not employers or HMOs.
“It’s a very different way of funding healthcare,” Edman said. “There’s a learning curve involved. The newness of it scares people a little – the financial end of it more than the medical.”
“In the local market, HSAs have been very slow to be accepted,” said Carol Hadlock of the Pittsburgh Technology Council’s Employee Benefits Group, referring to the greater Pittsburgh region.
“It’s been very small employers and sole proprietors who are taking advantage of the benefit and savings. Nationally, we see it taking off more than here. Where we see it being adopted locally, it’s been a total replacement of current healthcare coverage.
“In the mid-to-large market, we have clients planning to add HSAs over the next three years,” Hadlock explained. “They want to learn more about it before totally switching over. They’re taking the time to educate their employees. They are introducing higher deductibles, but not quite at the level of an HSA-qualified plan, and keeping their office visit and prescription drug co-payments.”
“This slow acceptance has nothing to do with the Blues in the Pittsburgh market,” said Hadlock. “Highmark offers qualified plan options. I think it is more a matter of employees being spoiled with that first-dollar benefit, and what’s needed is a change in their mindset. It could be that they’re worried about that upfront period, where they could be sitting with a big claim that has to be met as part of the deductible, before their HSA is fully funded.”
Truth is, people have become accustomed to having full healthcare coverage, with first-dollar coverage for hospital stays and other healthcare services, and perhaps a co-pay for trips to the doctor’s office, emergency room or to specialists. Adopting an HSA turns that model on its ear, so to speak. You’re moving into a new concept, a system where coverage doesn’t start until you reach a deductible. And a fairly high deductible, at that. So why would an employer or an individual want to switch?
The ABCs of an HSA
“As an employer, you should see a 30 to 40 percent drop in premium costs,” said Edman. “A special HSA bank account is established for each participant to save money needed to cover initial expenses under the deductible. The bank works with the IRS to make sure contributions to the HSA remain tax deductible. The only way it’s taxed is if you use it for something other than approved medical expenses – and that list is broader than you would expect, including certain over-the-counter medications.
“The HSA is a plan where it’s not a use-it-or-lose-it proposition,” he continued. “Unused funds roll over to be used in succeeding years. The incentive is to preserve money in the HSA. It’s up to consumers not to waste it, not to get unnecessary surgery, use generic equivalent drugs, and so on.
“In the past, there was no incentive to do any of those things,” Edman acknowledged. “Why worry about costs, when someone else is paying for everything? HSAs put power in the hands of the employee. It gets them some skin in the game. As a result nationally, we’re seeing fewer elective surgeries as a trend, for example.”
“You really have to sit down and do the math to see the savings,” added Hadlock. “Then the employer may contribute at least the first year’s deductible for each employee.”
Edman agreed, saying, “The big question is, when employers realize a 30-40 percent savings, what do they do with that extra cash? I advise my clients to use those funds to be more generous to their employees, and to help get their HSAs funded with an initial deposit from the employer.
A different way to pay
But employers aren’t the only ones achieving financial benefits through the proper management of healthcare options through HSAs, he said.
“In the two years we’ve had HSAs, fewer than 20 percent of participants are going through their high deductible and using the health plan portion,” Edman said. “Many people are rolling money over in succeeding years. That means, if costs are coming down because people are making better decisions, the funds will start to be built up over time and employers can cut back the amounts they kick in. It gives employers more control over the future of their healthcare costs, and enables employees to build up their savings to cover their deductibles easier.
“I tell people this is not better or worse than what they have now, it’s a different way to pay for your healthcare,” he said. “You buy car insurance in case you total your car, not for oil changes and tires, but that’s how we’ve been buying medical coverage in this country for decades. Now, we’re paying artificially high premiums to cover the insurance company’s overhead just to shuffle money around.”
“Typically, 20 percent of employees generate 80 percent of the claims, so those employers who educate their employees about being better healthcare consumers will reap the greater savings,” said Hadlock, who also used a car insurance analogy. “People have never had to shop for this before. They do it for car insurance, accepting a higher deductible for a lower premium. This works on the same principle. Healthy people who rarely use their healthcare benefits can certainly reap the benefits.”
Conventional wisdom asserts that skyrocketing healthcare costs won’t be contained until individuals can better appreciate the actual cost of the healthcare options they select. The Midwest Business Group on Health, an industry ad hoc organization, estimates that waste from poor quality and poor choices in healthcare options costs employers $2,000 per employee each year.
HSAs represent one option to help stem the tide by assigning greater personal responsibility and choice related to healthcare options. HSAs appeal to people concerned with saving for retirement and associated tax savings as well. Money saved in HSA accounts that is not used for medical care can be made available for private use upon retirement. It can be withdrawn sooner, but there’s an associated penalty.
So despite currently lagging behind national trends in adopting HSAs, what’s the outlook for Pennsylvania employers and their employees in climbing aboard this train?
“I think HSAs will be more accepted,” said Hadlock. “As this occurs, we expect more benchmarking data demonstrating the cost effectiveness of high-deductible health plans in conjunction with HSAs. It will prove to be one of the solutions employers find beneficial.”
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