Re: HSA verses HRA health accounts
 

I think it's more an issue of perception than reality, that the high deductible plans are worse for people with medical issues (by that I mean people who will often use their medical plan). I know it certainly feels more expensive to be paying significant sums when you use your healthcare, but you have to balance that with the savings you have made in the cost of your own premiums, and the fact that most employers put around 50% of the deductible into your HSA account for you to use (or keep for later, if you don't use).

Back in 2007 when these plans were quite new I administered the HSA plan for the small company I was working for, as well as being covered under the plan. My husband and I are relatively healthy and used very little healthcare at the time, and we saved a significant amount of money, I think it was around $2000, when you compared how much we'd have paid with the previous PPO plan. But I also worked out the figures for another employee whose wife had to have expensive eye care meds (plus they had the regular medical stuff of a family of four). For them it worked out about even, they could use that money the employer had put in the HSA first, and then the extra they spent was actually about the same as they would have paid in premiums with the regular PPO.

Most people don't have the info on the premium costs, so don't realise how much they save each month on those compared to the old style plans, but I think in most cases people come out even or ahead.

Re: HSA verses HRA health accounts
 

Given that employers are requiring employees to pick up more and more or the costs of non-catastrophic health insurance (through premiums, deductibles, and/or copayments) that wouldn't be too surprising, even though your example is unconvincing (none of the people you mention had a medical problem that required significant expenses on tests, surgery or doctors). But this really isn't the right comparison. What many employees are essentially doing is eroding the "value" of existing health benefits and then saying, "oh, there's this other option that you may be better off in". An option that not coincidentally does more to sheild employers from future premium rises, and which clearly moves more risk to individuals who are less healthy or have more risk of becoming so.

Re: HSA verses HRA health accounts
 

My husband this year chose to try his company's HSA rather than stay on my PPO. There were very few scenarios we could work out that would involve the HSA costing us more overall, once you took into account the lower premiums and the money his company put in.