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Health Savings Accounts

EBRI: ‘Very little growth’ in HSA enrollment 2014-2017

Enrollment in health savings accounts demonstrated "very little growth" between 2014 and 2017, according to a new analysis by the Employee Benefit Research Institute.

The reasons are not entirely clear and neither is the prospect that enrollment growth will continue to be modest in the future, said Paul Fronstin, author of an EBRI research report about the analysis, in an interview.

The growth rate "seems to have stalled," but there have been previous times when a slow-growth year in enrollment for HSA-eligible plans was followed by a stronger enrollment year, said Mr. Fronstin, who is also director of EBRI's health research and education program.

The EBRI analysis was based on a review of five HSA studies — including one by EBRI and the market research firm Greenwald & Associates. The surveys took different approaches, interviewed different populations and calculated different sets of numbers. For example, two surveys used interviews with individuals with private health insurance; two others interviewed employers to assess enrollment; and one survey made estimates about individuals with private health insurance based on information from insurers.

The common theme, however, was "how consistent the surveys are in finding slower growth than in the past," Mr. Fronstin said. Among possible contributing factors to slower enrollment growth is the fact that some employers don't believe the plan designs of HSAs are sufficiently flexible for their employees, said the EBRI report, which was published Tuesday. Another factor could be recent low health insurance premium increases and low unemployment rates dissuaded employers from shifting to an HSA-eligible plan, the report said. None of the surveys directly measured how many people dropped out of HSAs.

"Ultimately, more years and more research into this question are necessary to better understand the trends in HSA-eligible health plan enrollment," the report concluded.