While voters assess the stark contrast between President Barack Obama and Republican challenger Mitt Romney over health care reform, a sea change is already underway in the workplace as employers scramble for affordable ways to offer health insurance to their workers.

A new survey by the business consulting firm Aon Hewitt finds that "consumer-driven health plans," or CDHPs, have overtaken health maintenance organizations, or HMOs, as the second most popular health plan offered by U.S. employers. While preferred provider organizations, or PPOs, still dominate with 79 percent of employers offering them last year, 58 percent of the 2,000 U.S. employers surveyed now offer CDHPs, while just 38 percent offer HMOs.

Haven't heard of consumer-driven health plans? You may know them as high-deductible health savings accounts (HSAs) or health reimbursement arrangements (HRAs).

Their warmer, egalitarian-sounding name (with the word "consumer" in there) is preferred on the campaign trail this election cycle. The health care reform plank of the Republican platform recommends them, and GOP presidential candidate Mitt Romney singled them out for expansion when he signed the Massachusetts health care reform legislation in 2006.

Caught between the recession and the rising cost of health insurance, a growing number of employers now offer HSAs and HRAs as sort of a gateway plan to whatever comes next under health care reform.

Employees, however, have been less enthusiastic about CDHPs. The survey found that 7 in 10 workers prefer PPOs rather than risk the potentially heavy out-of-pockets of a high-deductible plan. So to sweeten the deal, roughly a third of employers surveyed either subsidize premiums, cover preventive medications before the deductible, or contribute directly to employee HSAsand HRAs.

Conservatives maintain that rampant overuse of health care services has led to the skyrocketing cost of health care and that the only way to reverse the trend is for consumers to take more responsibility for their health. Certainly the obesity epidemic would seem to support this position.

But is (cost)shifting the nation to high-deductible accounts the answer?

A recent study published in the journal Medical Care found that employees who contributed to their own HSA were more likely to moderate their use of health care services than those with employer-paid HSAs. The researchers noted that having "skin in the game" significantly altered whether an employee seeks care.

But that study also expressed concern that if employees skip routine exams and avoid early detection screenings for cost reasons, consumer-driven health plans could have a negative impact on public health.

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Can HSAs reform health care?