It may not be an issue that settles a swing state, but as Election Day nears executives who have a business stake in health savings accounts say the outcome of the vote could play a significant role in the outlook for their niche.
In general, executives said that their industry would be better off with John McCain as president rather than Barack Obama, but that view wasn't universal.
"The McCain team has more warmly embraced the consumer-directed health-care concept," said Paul Verberne, vice president and associate legal counsel for HSA Bank, a unit of Webster Financial Corp. of Waterbury, Conn. "We consider that administration to be a lot more favorable to the HSA concept."
Some observers, however, disputed the notion that Sen. Obama's planned health-care reforms would eliminate health savings accounts, and said that the reforms could provide an avenue for consumers to open more HSAs. It remains to be seen how the two candidates' reform plans might unfold once either takes office.
Sen. McCain is calling for deregulation of the health insurance market. He would allow consumers to buy out-of-state policies, which he says would lower costs by increasing competition. And he would tax employees on premiums paid by employers, but give tax credits that could be used to buy insurance on the open market.
Sen. Obama has said that he wants to preserve job-based insurance but extend coverage to individuals and small businesses through his National Health Insurance Exchange.
According to the Washington trade group America's Health Insurance Plans, 6.1 million Americans are covered by the high-deductible health insurance plans that can be paired with health savings accounts.
Dennis Triplett, the president of UMB Financial Corp.'s health-care services unit, said Sen. McCain's plan, with its free-market underpinnings, seems more amenable to health savings accounts.
"Individual responsibility and individual ownership has been part of his health-care plans all along," Mr. Triplett said in an interview. "I think it's much more likely that you'd see greater growth" of HSAs "in a McCain presidency."
Some executives said that they are concerned that an Obama victory Tuesday could be fatal to health savings accounts.
Michael F. Cannon, the director of health policy studies for the conservative Cato Institute, said "it would be open season" on HSAs if Sen. Obama is elected.
Industry members voice a more moderate view.
Mr. Verberne said that he and other bank executives had spoken with staff members from both the Obama and McCain camps recently, and "Obama's staff said that they are not looking to touch HSAs."
"They also say on their platform that, for those with health-care coverage in place, they are not looking to mess with that a lot," Mr. Verberne said.
Vik Kayshap, the chief executive officer of Canopy Financial, a San Francisco firm that provides HSA technology to banks, said it is unlikely Sen. Obama would do away with health savings accounts.
"We don't think the HSA itself is in danger of getting repealed or taken away," he said.
Sen. Obama's reform plan, which would require businesses to provide health insurance or pay into the new government insurance program, could push employers toward the cheapest insurance, which for many workers would be the high-deductible plans that are paired with health savings accounts, Mr. Kayshap said.
Stephen Neeleman, the chief executive officer of HealthEquity Inc. of Salt Lake City, a specialist in self-directed health products, said that if Sen. Obama's National Health Insurance Exchange allowed consumers to buy the high-deductible health plans, it could be a boon to health savings accounts.
The Clinton administration passed medical savings accounts into law, in 1996, so it can no longer be assumed a Democratic-led government would be hostile to health savings accounts, which came along in 2003, Mr. Neeleman said.
"It's not unheard-of for a Democratic president and Congress to pass a law that includes a provision that might appear to be more free-market-based," he said.
Mr. Triplett said that either candidate may well be constrained from putting their health insurance plans into action fully because of everything from differences with members of the House and Senate to a strained federal budget.
"I think we are more likely to have incremental change given the budget issues and the commitments we have elsewhere," he said.
Mr. Verberne said HSA providers cannot take anything for granted.
"We're optimistic that HSAs are going to remain a viable product, but are cautious at same time," he said. "I think the financial institutions collectively believe this is something we will have to continue to be strong advocates for."
