In what appears to be a wrenching decision, Kaiser Permanente is gearing up to begin offering health savings accounts, something that some point out contradicts the health plan's oft-stated philosophy that physicians, and not members' financial needs, will direct medical care.

HSAs were approved as part of the Medicare reform legislation passed by Congress about this time last year. Insurers across the country have been unveiling HSA programs and Kaiser officials admit that that's partially what pushed them to do the same.

"If all we offer at Kaiser is comprehensive coverage, then all of the sick people go to Kaiser and everyone else goes to the other plans," Arthur Southam, MD, Kaiser's senior vice president for product and market management, tells the Wall Street Journal.

Under the HSA program, members and employers may set aside money tax-free, either individually or through joint contributions. HSAs are available to members of health plans who have an annual deductible higher than $1,000 for an individual and $2,000 for a family.

The HSA development takes the old medical savings account formula and places it on anabolic steroids. Members and employers can set aside money tax-free, either individually or through joint contributions. But unlike MSAs, HSAs aren't focused on small companies and the self-employed. Anybody can play: big companies, medium-sized outfits, small firms, and the self-employed.

Funds can be invested and any unused portion of the annual contribution can be rolled over from year to year — a tempting prospect for healthy folks of some means engaged in personal financial planning. And it's entirely portable: Members can move their HSA from job to job and take their money along for the ride — just as they would a 401(k) account. The money can be employed for a variety of health care purposes — and acts as a backup resource to replace the swiftly evaporating pool of retirement health benefits.

The new HSAs would become available next year to Kaiser Permanente members in Colorado, Georgia, and the Northwest, meaning that about 25 percent of the health plan's 8.3 million members would have the option. It's hoped that HSAs would become available to California members in 2006. Southam says that members have been asking for the HSA option, and tells the Wall Street Journal Kaiser's coordinated approach to care will still make it stand out from other health plans.

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