Health Savings Accounts:
Participation Increased and Was More Common among Individuals with Higher Incomes
GAO-08-474R: Published: Apr 1, 2008. Publicly Released: Apr 30, 2008.
With health care spending increasing in the United States, you enacted legislation effective in 2004 establishing tax advantaged health savings accounts (HSA) to be coupled with high-deductible health insurance plans. HSA-eligible high-deductible health plans typically have lower premiums than traditional health plans and HSAs allow account holders to accumulate tax-free savings to pay for medical expenses. The novel structure of HSA-eligible plans coupled with HSAs has raised questions about who selects them and how they use the accounts. Proponents contend that the low premiums of HSA-eligible plans and the tax-free savings potential of HSAs appeal to many consumers, while the high deductibles encourage them to be more astute health care consumers. However, some critics are concerned that HSA-eligible plans may attract enrollees who seek lower premiums but lack the resources to contribute to an HSA, and wealthy enrollees who may seek to use the HSA primarily to accumulate tax-advantaged savings rather than pay for medical expenses. In a 2006 report, GAO described individuals' early experiences with HSA-eligible plans and HSAs and certain characteristics of HSA account holders. You asked us to update certain information from that report with more recently available data. For this report, GAO examined: (1) participation in HSA-eligible high-deductible health plans and HSAs, (2) the income characteristics of HSA account holders, and (3) contributions made to and withdrawals made from HSAs.
The number of individuals participating in HSA-eligible health plans and HSAs increased significantly between 2004 and 2007; however, in all years, many HSA-eligible plan enrollees did not open an HSA. The number of individuals covered by HSA-eligible plans increased significantly between September 2004 and January 2007--from about 438,000 to approximately 4.5 million, according to industry estimates. Despite the growth, these plans represented a small share of individuals with private health coverage--about 2 percent in 2006. The number of tax filers reporting HSA activity also increased, nearly tripling between 2004 and 2005, from about 120,000 to about 355,000. Industry estimates suggest continued growth in HSA participation in 2006 and 2007. Despite the growth in HSA participation, nationally representative survey estimates from 2005, 2006, and 2007 found that more than 40 percent of HSA-eligible health plan enrollees did not open an HSA. Tax filers who reported HSA activity in 2005 had higher incomes on average than other tax filers. Among tax filers between the ages of 19 and 64, the average AGI for filers reporting HSA activity was about $139,000 compared with about $57,000 for all other filers. The income differences existed across all age groups. The total value of all HSA contributions reported to IRS in 2005 was about twice that of withdrawals--$754 million compared with $366 million. Among all filers reporting HSA activity in 2005, average contributions were about $2,100, compared to average withdrawals of about $1,000. Survey estimates of the contributions employers made to employees' HSAs in 2007 varied. One employer survey reported average contributions for single coverage of $626 among large employers, while another employer survey reported average contributions for single coverage of $806 among small and large employers. More than a third of surveyed employers that offered HSA-eligible plans made no HSA contributions.