President Bush has been counting on Health Savings Accounts (HSAs) and other consumer-directed health plans to play a central role in his administration’s attempts to reform health care in the U.S., but the early results are less than encouraging. A number of studies show that the plans have been slow to catch on with consumers, and businesses that have adopted them have done so primarily for cost reasons.

A survey by the Kaiser Family Foundation found that only about 4% of covered workers were enrolled in HSA-type plans in 2006, a figure statistically unchanged from the previous year. While a number of favorable changes to the plans took effect early in 2007, so far, that has not resulted in a substantial increase in their adoption.

“Ultimately, we still don’t know whether workers and employers will embrace consumer-driven health plans in big numbers, but there certainly hasn’t been any groundswell of support so far,” says Gary Claxton, a Kaiser vice president.

HSAs and similar plans dangle the carrot of a tax deduction to wean consumers and employers from low-deductible insurance policies. Such “first-dollar” insurance coverage plays a central role in “dulling the incentives for consumers to shop carefully for cost-effective health care,” according to President Bush’s Council of Economic Advisors.

While there is anecdotal evidence coming in from parts of the country that suggests a gradual rise in the number of firms, especially small and mid-sized businesses – switching to consumer-driven plans, the trend appears to be nowhere near the tipping point proponents are looking for.

The two biggest stumbling blocks, experts say, are “selling” employees on the benefits of switching from a low-deductible to a high-deductible insurance policy (a key element of all HSA-type plans) and the need to do a better job of educating workers about the benefits such plans provide.