In the past few years, there has been considerable public scrutiny of health insurance costs for individuals and families, but much of the dialogue has ignored the growing economic burdens placed on working Americans. Over the past five years, the deductible for individual plan workers has grown seven times more than wages. The average deductible is currently almost $1,077, significantly higher than $303 in 2006.
Businesses have quietly shunted a greater share of the insurance plan costs to employees in an effort to minimize their financial responsibilities. This has, in part, been a response to the rapid rise in insurance premiums; a larger deductible enables companies to pay lower premiums. There is also a common belief that higher deductible plans will curtail medical care for low risk health issues.
Many employers also offer a health savings account program in which employees can deposit funds prior to taxation; these accounts may then be utilized to defray part of deductible costs. In 2015, almost 24 percent of all U.S. workers participated in these health savings account programs.
Almost 147 million working Americans obtain health coverage through their employer, with a large portion earning only a living wage. For many employed individuals and families earning wages of $10 to $15 an hour, a thousand dollar deductible often puts health care out of reach. This trend of HDHP's is likely to continue; a study by PricewaterhouseCoopers predicts that almost 44 percent of employers will offer HDHP's over the next three years.
A study by the Commonwealth Fund found that 14 million people were underinsured in 2014, almost 3 million more than in 2012. These underinsured had high deductible plans that had deductibles greater than five percent of their income. The study also found that another 24 million Americans had health insurance plans that were less burdensome, but still posed significant barriers due to co-insurance, co-payments and uninsured services.
Although the Affordable Care Act has helped millions of Americans obtain some form of health insurance, in many cases, that health coverage has deductibles too high to allow regular doctor visits. Instead, for many of these previously uninsured, their new policies serve as a safety net in the event of something catastrophic.
There is also a growing recognition that the increasing prevalence of high deductible health plans is creating a growing number of workers susceptible to chronic conditions. A report by National Public Radio found that one in five Americans are not getting the preventive care needed because of costs.
A study by FamiliesUSA found that almost 25 percent of American adults with individual health plans did not seek medical care due to high costs. Almost 15 percent did not obtain tests, treatments or follow up care, while almost 14 percent did not procure prescription drugs due to high deductibles. While there is no definitive evidence that patient noncompliance is harmful in the long term, there is considerable cause for worry that consumers who are forgoing care now are the most likely to suffer chronic illnesses down the road.
Article written by:
Robert Moghim, M.D.
CEO, Health Carousel Locum Tenens