High deductible health plans are increasingly common – more than half of all people who are covered by workplace insurance plans and 90 percent of those covered by health plans offered from state insurance exchanges are high deductible plans.
High deductible plans require policyholders to pay out of pocket for 100 percent of the cost of their medical care until they reach a deductible of at least $1,350 for an individual or $2,700 for a family. These are minimums. Many plans come with substantially higher deductibles that –- when a serious medical need arises -– are beyond the patient’s financial grasp.
This type of health insurance can leave patients struggling to pay their medical bills, forcing them to make healthcare decisions based on money instead of need. The looming matter of a financial debt undermines the patient-physician relationship, the health of the patient and the solvency of the medical practice. The consequences for patients and physicians are serious and need to be addressed.
Patients who cannot afford their healthcare because of a high deductible may trust their physician less, making them question whether recommended care is truly necessary. Patients may even cut ties with their physician altogether, as many are embarrassed to discuss personal finances with their medical professionals.
More worrisome is that patients with high deductible health plans are less likely to get the care they need. Research shows that patients with high deductible plans delay or forgo essential medical care because of the cost. Studies reveal that patients with high deductible plans do not return for important follow-up visits and skip free preventive services. As a result, physicians cannot diagnose and treat serious conditions, which ultimately harms patients and burdens the healthcare system.
Physician practices are struggling with debt incurred by patients with high deductible health plans. When patients cannot afford their care, independent physician practices -– which are often small, locally owned offices –- may not be able to afford to keep their doors open. Though physicians’ primary concern is helping people stay healthy and get well, their practices depend on revenue from private insurance to cover the costs of providing medical care.
It’s time for insurers to take back responsibility for health care payments. Connecticut needs to protect its patients and physicians with a better way to cover healthcare expenses. The best way I know how is for the state to institute a system that requires insurance companies to take back responsibility for covering the vast majority of medical expenses -– like they used to do, in the days before high deductible health plans.
I urge legislators to support and pass SB 902 (An Act Concerning High Deductible Health Plans), that has currently moved out of committee, a good sign but we need to push for this to become law. Patients would no longer be forced to choose between healthcare are and other expenses, and doctors could do what they do best – making and keeping people well.
David Emmel, MD, of Wethersfield is Legislative Committee Chair of the Connecticut State Medical Society.
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This is an excellent article and should garner a lot more attention that it is, as it is affecting everyone. The statement: “This type of health insurance can leave patients struggling to pay their medical bills, forcing them to make healthcare decisions based on money instead of need.” is 100% true and 100% counter to the concept of “insurance” in the first place. Consumers, which is everyone, if they are law-abiding insurance covered individuals, are all now paying higher premiums, with higher deductibles, and fewer “covered” services, all for the benefit of receiving less than first-world healthcare. For example, this year, along with my deductible, I am choosing to NOT get my annual breast screening, as my insurance company has deemed that the procedure I need for proper detection isn’t really a “routine” need, even though my mother died from breast cancer at 53. And while I am choosing not to pay for what I shouldn’t have to pay for (because I am already paying for it with my monthly premiums), I am fortunate as I do not live paycheck to paycheck. I can only imagine what the thousands of families across the state are “choosing” to forgo, to keep their medical costs down because they simply can’t afford it. C’mon America, and c’mon insurance companies. We can do better than this. Thank you David Emmel, MD for telling it like it is.