(AP Photo/Thomas Kienzle, File)

A few years ago, when Congress made health savings accounts (HSA) a reality, I remember getting excited and calling around to insurers to ask, “So, you’re going to be selling lots of cool HSA gap-filling products, right?”

The general response was: “Huh?”

Now, it seems as if the gaps are getting some respect. Hospital indemnity policies and accidental death and dismemberment policies are generating more buzz. Now critical illness insurance seem to be picking up steam.

One short-term reason is low, low interest rates.

When rates are high enough to generate solid returns on general account assets but low enough that the economy moves along, life insurers sell many products with long-term time horizons. All other things being equal, they like to sell lifetime annuities, long-term disability insurance and long-term care insurance under those conditions, because they can make more money on their own invests.

When the Federal Reserve Board pushes rates down to an artificially low rate, as it has today, short-term products are hot.

But another motivating factor is a combination of workers’ lack of liquid assets and the rapid increase in deductibles.

Many surveys have shown that, even at “traditional employer-sponsored preferred provider organization” plans, the typical deductible for hospital care is getting close to the minimum HSA deductible limit. Many individual health policies have deductibles of $10,000 or more.

Meanwhile, because of the effects of temporary bouts of unemployment and underemployment, the home equity value plunge, and credit card companies’ moves to lower credit limits, workers have no give in their budgets. They are tapped out, and the friends and relatives they might traditionally have turned to for help are tapped out.

I saw this first-hand earlier this year when I was doing complicated computations relating to how I would pay for summer camp for my daughter, on top of my regular bills, and two relatives and one friend who own micro-businesses came to me asking for emergency loans.

The margin between being broke, genteel poverty and plain old nasty poverty seems to be getting narrower.

The American Association for Critical Illness Insurance (AACII), Westlake Village, Calif., has teamed up with General Re Life Corp., Stamford, Conn., to conduct a critical illness insurance study.

The researchers found that 53% of 54$ of women who bought critical illness insurance policies in 2011 got policies with benefits of $20,000 or less — which is comparable to the deductible level for some individual policies 

About 29% of the male buyers and 31% of the female buyers bought policies with $10,000 or less.

One problem with the current crop of gap filling products is that they’re designed to fit snugly into regulatory loopholes. A hospital indemnity policy may or may not make an individual more likely to use the high-deductible health insurance that comes with an HSA, but, legally, it’s fine for an insurer to sell the hospital indemnity policy to an HSA holder, no matter what that might do to the HSA holder’s claims.

Another problem is that the current gap fillers leave strange gaps of their own. What if, for example, a healthy, fit consumer with a $20,000 major medical deductible and critical illness insurance comes down with a terrible case of the bird flu and runs up $20,000 in bills recovering from the flu? It seems strange that the consumer with the flu would end up worse off than a consumer who ate too much, smoked too much and proceeded to have an easily anticipated heart attack.

On the one hand: Stability is good. Insurers, consumers and producers need more major regulatory change like they need a hole in the head.

On the other hand: Maybe it would actually be good, once the fuss over the Patient Protection and Affordable Care Act is resolved, if lawmakers, regulators, insurers, producers, consumer groups, providers and other interested parties looked at the market from the standpoint that coverage for routine health care costs and coverage for catastrophic costs are two separate things and need separate rules.

On the third hand: Maybe insurers, credit providers and marketers need to climb out of the no-investment-risk implosion shelters they’ve been in for the past four years and come up with new product ideas. Maybe this is the kind of problem that a little ingenuity would quickly solve.