The Employee Benefits Research Institute and Commonwealth Fund have come out with their third annual survey of "Consumerism in Health." This edition is an improvement over earlier versions, though the commentary is every bit as negative as before. It is well worth looking at the underlying data if you can get beyond the infuriating narrative.

One example: In the front page summary the writers, Paul Fronstin and Sara Collins, lead off with the headline, "Enrollment remains low," and they say that consumer driven health plans (CDHPs) now cover 2% of the population. Yet, they also say that last year's survey found only 1% of the population being covered by CDHPs. This is a pretty amazing finding that should probably be headlined, "Enrollment in CDHPs Doubles in One Year!"

In fact, it is almost certainly not true that enrollment doubled between 2006 and 2007. No one else has reported such a surge. A growth rate of 50% is far more probable. That EBRI/CWF find otherwise is more a reflection of the horrible inadequacy of last year's survey, which we dealt with last year. This year's survey is much improved and the authors should be congratulated for heeding the criticisms from last year.

It is curious as well that the enrollment numbers are presented as a percentage of the population rather than as a percentage of the market. The authors do this to minimize the apparent impact of consumer driven health. After subtracting the people on Medicare, Medicaid, other government programs and the uninsured, we are looking at a benefits market of about 160 million, not the 300 million of the entire population. The authors report there are 2.3 million adults of ages 21 - 64 with savings accounts, 5.2 million with high deductibles that make them eligible to open an HSA, and 7.3 million with non-qualifying high deductible plans, for a total of 14.8 million adults with such coverage. Add another 25% for covered children and we get a total enrollment of about 18.5 million people, which would be 11.6% of the benefits market in 2007. This is probably pretty accurate, so the headline could read - "12% of Benefits Market Now Covered By Consumer Choice Plans!"

The authors also try to minimize the impact by saying, "Although CDHPs have been around since 2001, the market penetration is small." Although it is true that Definity had enrolled acouple of employers in 2001, the IRS didn't rule that these plans would be allowed until June of 2002. And, of course HSAs were signed into law on December 8, 2003 and were not widely available until mid-year 2004. So, any honest reading would have to say the coverage has been available for only four years and has already captured 12% of the benefits market. That is a sizzling rate of adoption.

So, we are fairly confident that the enrollment figures in this survey are reasonably accurate (even if the authors downplay the story). That gives us more confidence that the rest of the data is worth reviewing.

Greg Scandlen