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Tuesday May 28, 2019

Taking Aim at the High Deductibles That Drive Off Patients

"With my mind on my money and my money on my mind"
-- Snoop Dogg

[high deductible health plan with clipboard]

I'm pleased to have heard from many of you who took the time to read "Key Design Components and Considerations for Establishing a Single-Payer Health Care System,"(www.cbo.gov) the report from the Congressional Budget Office that I wrote about earlier this month. Regardless of your conclusions about that report, it's an important document worth ongoing consideration -- not least because of the appeal of a single-payer model to consumers who are worn down by the costs of their care.

Those costs are high and getting higher, a fact that's dominating kitchen table conversations, state and federal legislative sessions, and media headlines.

According to Kaiser Family Foundation data, the average annual insurance premiums in 2018(www.kff.org) were $6,896 for individual coverage and $19,616 for family coverage. Since 2013, premiums have increased 17% for individuals and 20% for families. More startling, that KFF data combined with CDC statistics show that during the past 20 years,(www.politico.com) premiums for individuals have swollen 214% ($2,196 to $6,896); during the same period, family premiums have been ratcheted up 239% ($5,791 to $19,616).

In the meantime, wages have not kept pace.

Over the past decade, then, an increasing number of American families have turned to high-deductible health plans as a means of lowering their coverage costs. Again relying on CDC statistics,(www.cdc.gov) among adults ages 18-64 with employment-based coverage, the percentage enrolled in a traditional plan decreased from 85.1% in 2007 to 56.6% in 2017. Over the same period, the percentage enrolled in an HDHP increased from 14.8% to 43.4%.

Regardless of your views on HDHPs, this is a major cost shift from employers to employees -- one that's having significant negative effects on the physical and economic health of Americans.

The deductibles associated with HDHPs have emerged as a major barrier to seeking and receiving health care. According to a Kaiser Family Foundation study,(www.kff.org) the average deductible for people with employer-sponsored insurance went from $303 in 2006 to $1,573 in 2018 -- a 402% increase. The average deductible(www.kff.org) for an individual purchasing a bronze plan from the marketplace in 2018 was $6,002.

As deductibles increase, individuals and families face tough choices that often put their health needs in competition with their financial resources. According to a 2017 Commonwealth Fund study,(www.commonwealthfund.org) a troubling number of adults with HDHPs and a deductible of $3,000 or more reported difficulties receiving needed care because the cost of doing so was prohibitive. Also because of cost, 23% reported that they did not fill a prescription, 30% did not see a physician or visit a clinic for a medical problem, and 47% had at least one access problem.

No reaction to that data was more resonant than that of Shelley Lyford, CEO of the health policy research firm West Health Institute, who said,(consumer.healthday.com) "It's shocking and unacceptable that medical bills strike more fear in the hearts of Americans than serious illness."

The AAFP agrees.

That's why the Academy this month helped launch Consumers First, a coalition focused on realigning the incentives and design of health care to allow the system to deliver the high-quality care that America deserves. This new bloc -- visible on social media with the hashtag #ConsumersF1rst -- has issued a call to action(familiesusa.org) that provides an overview of our health care system and shows how escalating prices and inequities in resource distribution are affecting individuals and families. The coalition will work with federal and state policymakers on six key issues:

  • high and rising health care prices;
  • distortions created by provider payment systems, including Medicare;
  • increased health care industry consolidation;
  • federal tax policy for nonprofit health care institutions and insurance plans;
  • flawed workforce policy; and
  • inadequate access to data and lack of transparency.

The coalition was formed by Families USA and also includes the American Benefits Council; the American Federation of State, County and Municipal Employees; the American Federation of Teachers; the Pacific Business Group on Health; and First Focus, which advocates for children and families.

It will release detailed legislative and regulatory objectives in the coming weeks.

The Academy also continues to back policies aimed at lowering costs and helping patients with HDHPs access their family physicians.

On May 16, U.S. Reps. Brad Schneider, D-Ill., and Elise Stefanik, R-N.Y., introduced the Primary Care Patient Protection Act,(schneider.house.gov) which the AAFP firmly supports. The legislation takes a common-sense approach toward assisting millions of individuals by requiring all HDHPs to cover two deductible-free primary care visits per plan year.

The legislation defines an HDHP as any plan with a deductible of $1,350 or more for an individual or $2,700 or more for a family. It appropriately promotes continuity of care, which has been shown(www.annfammed.org) to lead to healthier people and longer lives. And it builds in incentives for timely care, which, in many circumstances, helps patients avoid costlier health care episodes in the future. In 2016 the average emergency room visit cost $1,003 -- almost 10 times the cost of a visit to a family physician, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

The Academy also supports the Primary Care Enhancement Act, legislation I expect to be introduced soon in the House and Senate that also would help ensure timely and affordable access to family physicians and primary care.

It's hard to write about health care costs without mentioning prescription drugs. I will revisit our work on this issue in a future post. The AAFP remains engaged on several fronts in the battle against high prescription costs, most prominently in our work with the Campaign for Sustainable Rx Pricing.(www.csrxp.org) We also are working with several coalition partners to address the rising costs of insulin, an issue that affects millions of patients and thousands of family physicians who provide their care.

Posted at 09:52AM May 28, 2019 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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