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Update on MSAs, Now Called Health Savings Accounts (HSAs)

Congress enacted Health Savings Accounts (HSAs) in 2003 as part of the Medicare reform package. HSAs are essentially Medical Savings Accounts (MSAs), according to the Council for Affordable Health Insurance.  For information about HSAs, see:

The information and links cited above were updated on February 3, 2006. The following article about MSAs has been posted since 1998.

Misleading the Public About MSAs

by Sue A. Blevins

There is a big difference between what opinion polls find and what gets reported. This is especially true when it comes to Medical Savings Accounts (MSAs). Take a close look at the most recent Kaiser-Harvard survey on health care and you'll see that positive opinions about MSAs are ignored.

The Kaiser Family Foundation and Harvard School of Public Health conducted a telephone survey of over a thousand adults nationwide this past summer.(1) Respondents were asked a range of questions about the upcoming presidential election and health-care reform. In a press release describing the survey results, the Kaiser-Harvard research team stressed that respondents don't know too much about health-care reform and that questions regarding medical savings accounts were answered negatively. Newspapers reported those findings, leading the public to believe that people don't want MSAs.

Actual survey results, however, tell another story. Here are some survey results that were not reported by the mass media:

Thirty-one percent of respondents were positive about MSAs (14% very positive, 17% somewhat positive). Some 43% would likely choose a MSA if offered the $2,000 deductible plan (21% very likely, 22% somewhat likely). Those findings support a previous survey by the national Blue Cross and Blue Shield Association which found that 43% of employees would "definitely or probably" switch to a MSA if offered to them.(2) Clearly, despite the media blackout about MSAs (except to call them repeatedly health care for the "wealthy and healthy"), a significant number of Americans are positive about MSAs and want them.

In fact, more Americans view managed care and Medicare negatively, compared to MSAs. For example, the survey found that:

  • 22% were negative about Medicare
  • 21% were negative about managed care
  • 12% were negative about MSAs

So how come the headlines did not read "more Americans are negative about Medicare?" That important finding was not covered by the mass media. Instead, newspaper stories put a positive spin on Medicare, while covering only negative opinions about MSAs. For example, the New York Times' coverage of the Kaiser-Harvard survey said that only 30% of Americans had ever heard or read about MSAs and that no more than 28% favored creating them.(3) It ignored the fact that 43% of Americans would likely choose a MSA!

In determining how the public truly feels about MSAs, one should consider the way the survey questions are asked. For example, the Kaiser-Harvard survey questions about MSAs imply that employees' out-of-pocket costs would go up. Here is what respondents were told before they were asked about MSAs: "I'm going to give you some information about how Medical Savings Accounts would work, and then ask your opinion of them. Medical Savings Accounts would allow employers to purchase plans with lower premiums that would only provide coverage after the employee pays about $2,000/$5,000 a year in medical bills [the survey used two separate questionnaires, alternating the deductible amount from $2,000 to $5,000] . . . people would have to pay the first $2,000/$5,000 for doctor and hospital visits at the time they receive care . . . " (emphasis added).

That information is misleading because it implies respondents would have to dig into their own pockets for an additional $2,000 or $5,000 in medical expenses. It suggests that employee out-of-pocket expenses would go up.

Real-world experience, however, shows that employers take money currently spent on employees' health insurance and transfer it into each worker's MSA. Employee out-of-pocket costs do not go up, but are actually lowered with MSAs compared to traditional health plans, according to a study by Cleveland State University.(4)

Since that important information was not provided to respondents, it is no wonder 36% said they don't know enough about MSAs to have an opinion.

By taking a closer look at the Kaiser-Harvard survey results, it is clear that you can't judge a survey by its cover. Let's hope the media do a better job of "opening the books" to report both sides of health-care reform issues, especially the significant public support for MSAs.

Sue A. Blevins is president of the Institute for Health Freedom in Washington, D.C.


1. "Survey of Americans on Health Policy: Questionnaire and National Topics, July 30, 1996," by The Kaiser-Harvard Program on The Public and Health/Social Policy (a joint program of The Henry J. Kaiser Family Foundation and Harvard University). A copy of the survey questionnaire and responses can be obtained from the Kaiser Family Foundation (415) 854-9400.

2. "Legislative Malpractice," The Wall Street Journal, March 27, 1996.

3. Adam Clymer, "Public Lacks Strong Opinions on Health Bill, Survey Shows, The New York Times, July 31, 1996.

4. Michael T. Bond, Brian P. Heshizer, and Mary W. Brivnak, "Reducing Employee Health Expenses with Medical Savings Accounts," Compensation and Benefits Review, Sept./Oct. Issue, Vol. 28, No.5, 1996, pp. 51-56. (unpublished manuscript, 1996).

This article appeared in Medical Sentinel, Volume 2, Number 4, Fall 1997.