Year after year, in survey after survey, executives have identified the rising cost of healthcare in the U.S. as one of their principal economic concerns. While federal and state governments could definitely do more to ease that corporate burden, companies must look closer to home for alternatives, particularly among the various forms of consumer-directed healthcare, which give patients both greater control over their care and a stake in managing costs through such strategies as the blend of a high-deductible health plan and a Health Savings Account (HSA). The hope is that consumerism can rein in medical costs while ensuring continued health coverage for workers, but its promise has not been fully realized. Consumerism has made only limited inroads. The Center for Studying Health System Change found that only one in five workers with a choice of health plans selects a consumer-driven plan.

If healthcare consumerism is to succeed, it needs to be more widely accepted, especially since it still faces opposition from special interests. Employers, however, can take three steps to support consumerism, both in their own companies and nationally.

First, businesses need to educate employees about the benefits. Workers with traditional health insurance plans need to understand how consumerism can help control their own costs and, while they may involve more up-front costs, consumer-directed plans are preferable to potentially having limited or even no insurance coverage.

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Second, businesses should make consumer-driven plans more effective and easier to use. Employers could contribute to HSAs; enable workers to make HSA contributions through payroll deductions; and offer features such as convenient healthcare debit cards and the opportunity to invest HSA assets in a wide variety of investments, potentially providing employees an additional source of retirement funds akin to a 401(k).

Third, businesses can support legislation to make consumer-driven plans more flexible. Legislation signed by President Bush in December 2006 raises the annual limit on HSA contributions, allows workers to contribute the maximum regardless of when they sign up, and permits one-time rollovers to an HSA from a flexible spending account, a health reimbursement account or an individual retirement account.

Further reform could make HSAs even more attractive. Employers can support legislative initiatives such as those which would allow chronic care management to be covered before the annual deductible is met; permit "certain" expenses that are incurred before the establishment of the HSA to be treated as qualified medical ex- penses if they meet defined parameters; and make it possible for workers to establish HSAs without having to join a high-deductible plan.

Consumer-directed healthcare offers a great opportunity for employers, but it needs more active support for it to have a meaningful impact on healthcare costs.

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