The document lists the top 10 reasons people are not using their health savings accounts (HSAs). The number one reason is lack of education, as people do not understand what an HSA is or how it can be used. Other common reasons include not knowing that HSAs can be used for non-medical expenses, that funds can be invested for future use, or that employers sometimes contribute to the accounts. Overall, the document suggests that more education is needed to help people take full advantage of their HSAs.