Studies suggest significant out-of-pocket costs may harm low-income and chronically ill patients
TUESDAY, Jan. 10, 2017 (HealthDay News) -- High-deductible health plans have multiplied in recent years. But they may pose a significant financial burden on Americans with chronic conditions, two new studies suggest.
One study finds a greater likelihood that out-of-pocket spending for health care will consume 10 percent or more of family income for someone with a long-term condition such as arthritis, high blood pressure or a mood disorder and a high-deductible insurance plan.
The other shows that seriously ill and low-income people in high-deductible plans delay care for diabetes complications.
A high deductible means you pay more before insurance kicks in. People who study health policy say high deductibles may have the unintended consequence of deterring ill and financially vulnerable Americans from getting needed medical tests and treatments.
"We need to give [health] plans flexibility to be able to cover more things pre-deductible," said Dr. Mark Fendrick. He is director of the University of Michigan's Center for Value-Based Insurance Design.
The studies were published online Jan. 9 in JAMA Internal Medicine.
The reports are timely because the incoming Trump administration and Republican leaders in Congress have embraced health savings accounts (HSAs) as a model for replacing the Affordable Care Act, which is also known as Obamacare.
Health savings accounts, when linked to high-deductible health plans, provide tax incentives for Americans to save money toward their out-of-pocket medical expenses.
The problem is that Internal Revenue Service regulations do not allow health plans to waive deductibles for an existing illness, injury or condition, said Fendrick, whose editorial on the topic appears in the same issue of the journal.
The law should be amended so that people with chronic conditions receive "high-value services" before having to meet a deductible, he said. That would mean, for example, allowing patients with diabetes to fill prescriptions for insulin and have hemoglobin A1c testing and exams pre-deductible.
"The best way to move forward on this issue is to understand that we should be buying more of the things that make Americans healthier and less of the things that don't," Fendrick said.
Last year, 51 percent of workers were covered by employer health plans with deductibles of $1,000 or more, according to a Kaiser Family Foundation and Health Research & Educational Trust survey.
In addition, most marketplace plans under the Affordable Care Act feature high deductibles.
Researchers from the Veterans Administration Ann Arbor Health Care System and Penn State University used data from a national survey of adults under age 65 to assess the impact of high deductibles. They examined patients' out-of-pocket costs across a range of chronic health conditions.
The study included more than 17,000 people with high, low or no deductibles. About 45 percent had at least one chronic health condition.
Annual out-of-pocket spending on medical care varied greatly, even among people with the same chronic condition, the study found.
But contrary to prior studies, people by and large appeared to get the care they needed.
That could be viewed as promising news, explained Joel Segel. He is assistant professor of health policy and administration at Penn State. But he sounded a note of caution: Instead of delaying or skipping care, people with chronic conditions may be receiving care that poses "a significant financial burden," he said.
"We may have to continue to monitor this issue to ensure that they do not delay or forgo necessary care," Segel said.
The other study examined diabetes outpatient care and complications after an employer-mandated switch to high-deductible coverage involving more than 12,000 plan members with diabetes.
Overall, there was no significant change in primary care visits or disease-related testing.
However, certain vulnerable patients had negative outcomes. For example, emergency department visits for acute complications among low-income people increased 20 percent. And costs for ER visits by people with health savings accounts rose 30 percent, the study found.
Dr. Frank Wharam, an associate professor at Harvard Medical School in Boston, led the diabetes study. He stressed the importance of additional research to monitor high-deductible-related patient outcomes.
The U.S. Internal Revenue Service has details on health savings accounts and high-deductible health plans.