Are High Deductibles a Middle Class Health Curse?

Dilemmas over Deductibles: Costs Crippling Middle Class: Rather Than Pay So Much Out-of-Pocket, Many Skip Checkups and Scrimp on Care.

Title of January 2 USA Today Report, by Laura Unger and Jayne O’Donnell

Are high deductible health plans, the fastest growing segment of the health insurance industry which cover 150 million Americans, a good or bad thing?

Proponents tout these plans as good. Employers like them because the health benefits they provide cost less. Employees like them because they often cut premiums in half and because they can set aside money for retirement and other purposes. Conservative critics like them because health plan holders have “skin in the game” and shop more prudently when they know must pay part or all of the deductible their own money.

But when it comes to actually getting care, health consumers blanch when they total up the costs of deductibles, co-pays, co-insurance, and other expenses and when they see government picking up the tab for the other half of the population in Medicare, Medicaid, health exchanges, and Tricare programs for the military.

In their USAToday piece, the authors argue that high deductilbles in various sections of the country - $1307 in the West, $1295 in the Midwest, $1172 in the South, and $1099 in the Northeast – have simply made health care unaffordable for 4 of 10 adults.

How consumers react to these deductibles comes down to cost and whether the costs are less or more than 5% of consumers’ income. If it is more than 5% of income, roughly half of consumers don’t go to the doctor unless absolutely necessary, don’t get preventive care, skip their doctors’ appointment, and don’t choose to see a specialist.

Why is this? Because consumers must pay the deductible before their insurance kicks in. Deductible plans are growing rapid, with 41% of workers now having them, and the size of the deductibles have more than doubled over the last years, particularly during the 6 years of the Obama administration.

What and who to blame for the crippling costs of deductible, co-pays, and co-insurance and various other out-of-pocket costs as costs are shifted to consumers. Corporate greed of business owners and health plans? Inflated costs and incomes hospitals, doctors, and other health professionals? Advances in technology, such as those new brand name drugs or those MRI, CT, and Pet scans?

Or is ObamaCare the culprit with those failed promises to lower costs by $2500 per family and to keep your health plan and doctor, and more spending on the poor and less on the middle class.

Maybe. Maybe not. The health law covers preventive care and routine physicals for many patients, forbids exclusion for pre-existing illnesses, covers young adults under 26 under parents’ plans, and limits out-of-pocket expenses to $6300 for each individual. Unfortunately many consumers are not aware of free preventive services and patient protections. And government does not protect against the costs of chronic drug regimens or common surgical procedures or emergency room visits which often run into thousands, even hundreds of thousands. of dollars.

These days there is much talk about President Obama’s domestic legacy. Will it be that he insured most of the uninsured? Will it be that he set in motion forces for universal coverage? Or, conversely, will it be that he saddled the middle class and their children and grandchildren with unaffordable costs while attempting to redistribute wealth and health benefits? At the moment, these questions are unanswerable.