A minimally publicized report on the income characteristics of account holders published by AHIP used information on one million account holders from the five largest HSA banks. Since it didn't have direct income information on these accounts, it used the average income in the census tracts where the account holders live, which is a pretty accurate gauge.
The study breaks income groupings into five categories and found:
- 3 percent of account holders were in the lowest income group;
- 45 percent were in the next lower-middle income group;
- 34 percent were in the middle-income group;
- 12 percent were in the upper-middle income group; and
- 5 percent were in the upper-income group.
The report does not say what portions of the overall population fall into each group, so it is impossible to say if account holders are over- or under-represented in any of the categories. But the account activity of each group in 2008 is very interesting because the deposits and withdrawals are very much the same, even though the income levels are vastly different:
- Low Income -- $784 input, $489 outgo;
- Low Middle Income -- $958 input, $608 outgo;
- Middle Income -- $1,202 input, $742 outgo;
- Upper Middle Income -- $1,464 input, $892 outgo; and
- Upper Income -- $1,766 input, $1,051 outgo.
Anyone who says that HSAs are a "tax shelter for the rich" are sadly misinformed. Ask any hospital CFO about where the bad debt is coming from these days. Remarkably, this population is also more likely to find a less expensive provider outside their home community as a prudent shopper. If asked to pay in advance in order to access a significant savings, they will often pay in advance.
About the Author: 
Maria K Todd, MHA, PhD is known around the world for her expertise and generosity in sharing ideas, techniques and practical tools with her colleagues in the industry. She is a leading health care industry consultant and described by clients and peers as a visionary and thought leader. Statistically, she is the leading trainer in managed care contracting worldwide. Since 1989, she has lectured professionally through colleges, universities, seminar companies, publishers and non-profit professional associations as well as on-site private training classes for hospitals, medical groups, offshore revenue cycle business process organizations and pharmaceutical and medical device manufacturers. In total she has delivered more than 2600 managed care training classes and seminars to over 53,000 attendees and participants. Every month the number grows higher and higher!
Conflict Disclosure: The author is a professional consultant and derives a substantial percentage of her income reviewing managed care agreements and advising hospitals, physicians and others on matters regarding managed care and contracted reimbursement. The author previously worked for a Health Plan in provider relations as a contract negotiator. The author has no other conflicts to declare. This disclosure accurate as of November 5, 2008.
Notice: Please remember that the opinions, and information contained in this document is that of the individual author. These materials (1) do not constitute legal advice; (2) do not form the basis for the creation of any relationship; and (3) should not be relied upon without seeking specific legal advice with respect to the particular facts and current state of the law applicable to any situation requiring legal advice. These materials may only be reproduced with the prior written consent of Maria Todd. These materials are provided with the understanding that the author is not rendering legal, accounting, or other professional advice or opinions on specific facts or matters, and, accordingly, such entities assume no liability whatsoever in connection with their use.
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