A recession and a new president did not dissuade SunTrust Banks Inc. from announcing in mid-December that it was getting into the health savings account business.

Executives at the Atlanta company say they are hopeful that the Obama administration will include HSAs — and the high-deductible insurance plans that must be paired with them — in expected health care reforms. In addition, the executives argue that the recession will make a consumer-directed approach to health care more appealing to businesses.

"The recession will probably raise awareness for high-deductible health insurance plans," said Brad Jones, the SunTrust first vice president of product development who oversees its HSA.

Health savings accounts and deposits have grown steadily since their creation through a 2003 law, and according to industry experts, this year was no exception. But bank executives and others in the HSA business say next year is full of question marks for the product.

In a favorable scenario, HSAs would continue their strong growth, possibly abetted by some regulatory changes, said Alexander Domaszewicz, principal and senior health care consultant at the consulting firm Mercer LLC.

For instance, federal lawmakers could ensure that HSAs are taxed the same way in all 50 states, and the process for rolling assets into HSAs from products such as flexible savings and health care reimbursement accounts could be simplified, he said.

According to Mr. Jones, in a best-case scenario, if employers were mandated to offer health insurance, they could pile their assets into HSAs, which are relatively inexpensive.

On the other hand, Mr. Domaszewicz said HSA custodians, with their slim profit margins, could be badly hurt if the federal government required employers to ensure that the accounts are being used properly. Currently that requirement lies with individual account holders.

Such a change would be "catastrophic" for banks, he said, because employers would almost certainly pass that responsibility along to them.

Also, the entire industry would likely suffer if means testing or income limits were applied to HSAs, Mr. Domaszewicz said.

A tax law change could eliminate the accounts altogether, though experts call that scenario unlikely.

Todd Berkley, vice president of account-based solutions at OptumHealth Financial Services, a business unit of OptumHealth Inc. of Golden Valley, Minn., said the odds of that happening are not strong.

In President-elect Barack Obama's speeches on health reform, "We keep hearing, 'If you like what you have, you can keep it,' " Mr. Berkley said. "We hope they mean that."

At the end of the third quarter there were 6.2 million health savings accounts, according to Information Strategies Inc., a Palisades Park, N.J., firm that tracks the products. By the end of next month it expects that total to increase to 7.1 million — a figure that would be double the total 12 months earlier.

The past year was not good for all banks in the HSA business. Several — most notably Union Bank of California in San Francisco, now a unit of Mitsubishi UFJ Financial Group Inc. in Tokyo — gave up servicing HSAs, because of their uphill climb to profitability.

What's more, Mr. Domaszewicz said this past year showed that getting employers to adopt HSAs and high-deductible insurance plans is far easier than signing up individual employees.

"It's that 'second sale' that people aren't taking into account," he said.

Janet Guthrie, a senior business leader of health care solutions for MasterCard Inc., which provides card services for HSAs and related products, said there is a "direct correlation" between companies' success in signing up employees and the employers' willingness to contribute to their accounts.

A handful of financial institutions have built hefty HSA operations with an eye toward long-term profitability. They include HSA Bank, a unit of Webster Financial Corp. of Waterbury, Conn.; OptumHealth Bank, a unit of OptumHealth Financial Services; UMB Financial Corp.; and Wells Fargo & Co.

SunTrust hopes to be a long-term factor in the business. Mr. Jones said the company waited to jump in because it wanted HSAs to gather steam and consumer tools to improve.

"We felt we would have a competitive advantage, because we would be leveraging that second-generation technology," he said.

Gary Plourde, a senior vice president with SunTrust and director of sales of SunTrust Institutional Investments, said the company will focus its HSA sales efforts on companies with between 100 and 5,000 employees.

"The middle market is struggling with how to control their health-care dollars and provide strong benefits to employees," he said.

Most of SunTrust's target companies will not have open enrollment for benefits until late next year, Mr. Jones said.

SunTrust will use the extra time to ensure that the rollout of its HSA product goes smoothly, he said. "We want to be sure that our first impression in the market is a positive one."

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