Consumer-Directed Health Plans and Health Savings Accounts: Have They Worked for Small Businesses?

Abstract

Cost has deterred the majority of small businesses from providing health insurance to their workers. Consumer-directed health plans, which are potentially less costly than traditional health plans, may be well suited to workers in small businesses. The authors study the factors that are associated with CDHP offering, determine the variation in CDHP offering among large and small firms, and develop models of persistence in CDHP offering. Their analysis of the Kaiser-HRET survey shows that small firms have been no quicker in their uptake of CDHPs than larger firms, and appear to display somewhat more churning in CDHP offering than large firms. Small firms that employ between three and 49 workers are less likely to offer HRA/HSA plans than large firms. Furthermore, firms that employ 200 to 499 workers appear to be less likely to offer both HRA/HSA plans and HD plans compared to larger firms. Their results suggest a limited role for the current incarnation of consumer-directed health plans in encouraging small business to provide insurance.

Keywords: health insurance, consumer-directed health plans, small business

JEL Classification: H51, I11