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Whatever the result of next month's election, momentum is rolling toward consumer-directed health accounts. In the open-enrollment period that thousands of companies are holding this season, many will begin offering health savings accounts - high-deductible insurance linked to tax-sheltered accounts. Less than one-tenth of employers are expected to offer them this year, but the plans are expected to grow substantially in the next few years.

The changes in the law gave consumer-directed health care a new impetus. Aetna, which began offering consumer-directed products in 2001, stepped up efforts. And just before Congress passed the health reform bill, UnitedHealthcare, the country's largest health insurer, bought Golden Rule Health Plans, a niche specialist in consumer- directed plans, for $500 million.

Maryland's tightly regulated small-employer market - the only coverage companies with 50 or fewer workers are allowed to offer in the state - permitted a high-deductible plan linked to an HSA for the first time in July. Aetna Inc. is among the companies beginning to offer small-employer HSA products.