Health savings accounts (HSAs) have altered the health care landscape in ways no one might have predicted. HSAs have emerged as a valuable tool in the quest to change consumers' health care spending behaviors and better manage health care costs. This article compares and contrasts HSAs to other health care spending accounts, addresses various HSA topics in the context of HSAs' first six years, and speculates on the future of HSAs. The authors identify policy changes that could help expand HSAs, drive further employer savings, make HSAs more user-friendly, impact employee satisfaction and increase adoption rates.