The most obvious risks associated with HSAs and other consumer-driven approaches apply to individuals with compromised health status or limited income. The largest advantages of HSAs accrue to consumers in the highest tax brackets,because contributions to these accounts operate as tax shields. Consumers in the lowest tax brackets
are more likely to experience daily challenges in meeting their basic household expenses. Low- and moderate-income consumers are more likely to lack the discretionary income to contribute to an HSA.
In addition, being subject to a lower tax rate means a substantially smaller tax break than that experienced
by wealthier taxpayers.A Commonwealth Fund task force concluded that "health savings accounts are not likely to be an important contributor to expanding coverage among uninsured people because most of them do not face high-enough marginal tax rates to benefit substantially from the tax deductibility of the HSA contributions