EBRI Issue Brief

Examining HSAs Through a DEI Lens

Apr 7, 2022 15  pages


  • Health savings accounts (HSAs) are a useful way for people enrolled in high-deductible health plans (HDHPs) to save and pay for medical expenses. While previous research has examined contribution, distribution, balance, and propensity to invest HSA balances, little is known about how usage varies by accountholder demographic. The Employee Benefit Research Institute (EBRI) has leveraged accountholder data from its HSA Database to examine the extent to which HSA contribution, distribution, and investment behavior differ based on the accountholder’s race, ethnicity, gender, and income.
  • In this Issue Brief, EBRI’s analysis finds stark differences in HSA behavior based on accountholder race, ethnicity, gender, and income. For instance, accountholders living in disproportionately White or Asian ZIP codes contributed and withdrew more than their counterparts living in disproportionately Black or Hispanic ZIP codes. Similarly, male accountholders made larger contributions and had higher balances than female counterparts, as did higher-income accountholders relative to lower-income accountholders.
  • Disparities in HSA account balances along racial, ethnic, gender, and income lines are not adequately explained by the length of HSA ownership. Instead, the disparities EBRI observes appear to be largely driven by contributions.
  • There is ample evidence supporting the existence of health inequities among race, gender, and income lines. To the extent that accountholders take advantage of the benefits HSAs offer, HSAs may reduce health inequities. However, to the extent that HSAs are not well-utilized, they may serve to exacerbate health inequities.