Employers have been interested in bringing aspects of consumerism into health plans for many years. As far back as 1978, they adopted Sec. 125 cafeteria plans and flexible spending accounts. More recently, employers have been increasingly turning their attention to consumer engagement in health care. In 2001, they introduced account-based health plans–a combination of health plans with deductibles of at least $1,000 for employee-only coverage and tax preferred savings or spending accounts that workers and their families can use to pay their out-of-pocket health care expenses. A few employers first started offering account-based health plans in 2001, when they began to offer health reimbursement arrangements (HRAs). In 2004, they started offering health plans with health savings accounts (HSAs). By 2009, 15 percent of employers with 10-499 workers and 20 percent of employers with 500 or more workers offered either an HRA or HSA-eligible plan. Employers have also taken a broader approach to consumer engagement through various other initiatives.