A survey by the American Association of Preferred Provider Organizations found that consumer-directed health plans were the only type of insurance plan that saw positive growth in 2009. The Mercer National Survey of Employer-Sponsored Health Plans found that 23 million people were enrolled in CDHC plans last year, up 27 percent from 2008.

Growth was driven by small employers, 15 percent of whom offered CDHC plans, up from 9 percent in 2008. While large employers are more likely to offer the plans, the percentage of large employers offering CDHC plans remained steady at 20 percent from 2008 to 2009. Still, 18 percent of small employers and 24 percent of large employers say they are very likely to implement such a plan this year.

While employers tend to favor plans that offer an HSA, employees are more likely to sign up for a plan with an HRA. The study attributes this preference to the fact that not all HSAs include an employer contribution.