Patients Pay Price For High-Deductible Health Plans

Studies link HDHPs to delayed care, medical debt and disposable income.

The moderation in health care cost increases over the past several years appears to be benefiting everyone except patients.
 
That’s the takeaway from two new studies that correlate the growth in high-deductible health plans (HDHPs) to more enrollees delaying needed care, more enrollees incurring medical debt and more enrollees spending more of their income on health care services.
 
A number of surveys have documented the steady climb in the number of employers offering HDHPs to workers and the number of workers enrolled in HDHPs. For example, 28 percent of employers offered a HDHP option to employees this year, up from 10 percent a decade earlier in 2007, according to a survey of nearly 2,000 employers by the Kaiser Family Foundation and the Health Research & Education Trust. A separate survey by United Benefit Advisors of nearly 20,000 health plans offered by more than 11,000 employers found that the number of workers in HDHPs rose to 26.4 percent this year from 21.7 percent in 2015.
 
Although the use of HDHPs by employers and available to consumers through ACA-mandated state and federal health insurance exchanges may be saving their sponsors money, two new studies point to some negative consequences for those who obtain their health benefits through the plans.
 
The first, by researchers from the Robert Graham Center of the American Academy of Family Physicians, found that people with chronic medical conditions like diabetes or high blood pressure were more likely to be enrolled in HDHPs, more likely to incur medical debt and more likely to delay or avoid care.
 
For example, 52 percent of people with three or more chronic medical conditions enrolled in plans with annual out-of-pocket expenses of $2,000 or more incurred medical debt compared with 28 percent of those with no chronic medical illness. Further, 25 percent of people with three or more chronic medical conditions enrolled in plans with annual out-of-pocket expenses of $2,000 or more delayed or avoided care compared with just 9 percent of those with no chronic medical illness.
 
The second study, from the Commonwealth Fund, found that families spent an average of 10.1 percent of their annual household income on health insurance premiums and deductibles in 2015, up from 6.5 percent in 2006. The study attributed the change to wage increases over that 10-year period not keeping up with increases in employee contributions to health benefits costs.
 
The trend in Minnesota mirrored the trend nationally, according to a state-by-state breakdown in the study. In 2015, Minnesotans spent 9.4 percent of their annual household incomes on health insurance premiums and deductibles compared with 5.5 percent in 2006.
 
“People living in states with a combination of higher average deductibles and lower median income may be particularly at risk of going without needed care because of costs,” the Commonwealth Fund said in a press release announcing the study results.