High-Deductible Health Policies Linked To Delayed Diagnosis And Treatment
April 18, 20195:00 AM ET
Erika Stallings


The out-of-pocket expense of mammograms, MRIs and other tests and treatments can be several thousand dollars each year when you have a high-deductible health policy.

In 2017, Susan learned that she carries a genetic mutation that may elevate her lifetime risk of developing breast cancer to 72 percent.
Her doctor explained that individuals who have this mutation in the BRCA2 gene have choices in treatment. Some people opt for a preventive double mastectomy. But Susan could instead choose to undergo increased cancer screenings, which, for her, would mean an annual mammogram and annual MRI scan.

Because she had just had her first child, Susan chose increased surveillance - that meant she'd be able to preserve her ability to breastfeed.

Both Susan and her husband, who make their home in Broomall, Pa., have insurance provided through their respective employers to help pay for medical treatment. But there's an expensive hitch: These annual scans she'd need would be pricey, and their companies offered only high-deductible health plans.

"High-deductible plans are really the epitome of the access-to-care problem. People don't have the liquid cash to meet their deductible, so you see delays in care or even avoiding treatment altogether."

Susan's annual deductible for her plan (which covers her and her child) is $6,000 annually. (NPR has agreed to use only Susan's first name because she worries any publicity might jeopardize her job.)
"I've worked at my employer for 17 years," she says. "When I first started, there was no paycheck deduction for health insurance and my copay was only $5. But in 2011, my employer switched to only providing high-deductible insurance plans."

Susan went in for her first mammogram and MRI in February 2017. Her out-of-pocket cost for the MRI was more than $2,000. The bill for her mammogram was $1,088 (although she was eventually able to appeal and have the charges for the mammogram reduced to $191).

As a result of the high bill, Susan decided to put off her 2018 annual screenings until she had dealt with paying off the bills from 2017.

Susan's story of delaying care because she's underinsured is not an outlier. A study published last month in Health Affairs examined claims data from a large national insurer for 316,244 women whose employers switched insurance coverage from low-deductible health plans (i.e., deductibles of $500 or less) to high-deductible health plans (i.e., deductibles of $1,000 or more) between 2004 and 2014.

The study group consisted of women who were in low-deductible plans for one year, then switched to a high-deductible plan for an additional one month to four years. The control group consisted of women who remained in low-deductible plans.

In particular, the researchers looked at the relative effects of such plans on women who have low incomes versus those with higher incomes.

Women with low incomes who had high-deductible insurance plans waited an average of 1.6 months longer for diagnostic breast imaging, 2.7 months for first biopsy, 6.6 months for first early-stage breast cancer diagnosis and 8.7 months for first chemotherapy, compared with low-income women with low-deductible plans.

In some cases, delays of that length might lead to poorer health outcomes, says J. Frank Wharam, an internist and specialist in insurance and population health, who led the study. More research needs to be done to confirm that, he says.

Interestingly, women with high incomes who relied on high-deductible health plans were not immune to such delays - they experienced lags of 0.7 months for first breast imaging, 1.9 months for first biopsy, 5.4 months for first early-stage breast cancer diagnosis and 5.7 months for first chemotherapy, compared with high-income women with low-deductible plans.

The researchers also found that having a high-deductible health plan was linked to delays in care whether the women lived in metropolitan areas or not and whether they lived in neighborhoods that were predominantly white or predominantly nonwhite.

"In general, we are finding that the effects of modern high-deductible plans on access to care are sometimes predictable but often surprising," Wharam explains.

"In addition to well-recognized factors that can influence how quickly a patient is diagnosed and treated - such as income and education levels - other aspects of her life likely play a role too," he says, such as her familiarity with her disease and insurance benefits, her previous experience interacting with an insurer, her tolerance of risk and her familiarity and ease with the health care system and its jargon.

Other recent studies have noted similar delays in diagnosis and treatment for complications from diabetes, cardiovascular illness and other conditions. And a report from the Kaiser Family Foundation in 2017 found that 43 percent of adults with health insurance reported difficulties in meeting their deductible - up from 37 percent in 2015.

Dr. Veena Shankaran is co-director of the Hutchinson Institute for Cancer Outcomes Research at Seattle's Fred Hutchinson Cancer Research Center, where her work focuses on studying financial challenges experienced by cancer patients. Though not involved in the Health Affairs study, Shankaran says the findings don't surprise her.

"We're seeing that high-deductible plans are really the epitome of the access-to-care problem," she says. "People don't have the liquid cash to meet their deductible, so you see delays in care or even avoiding treatment altogether."

According to data from the Centers for Disease Control and Prevention, from 2007 through 2017, enrollment in high-deductible health plans that are linked to a health savings account increased from 4.2 percent to 18.9 percent among adults 18 to 64 who had job-based coverage, while enrollment in high-deductible health plans without an HSA increased from 10.6 percent to 24.5 percent in that same age group.

Meanwhile, enrollment in more traditional workplace plans decreased.

The Patient Access Network Foundation, a nonprofit in Washington, D.C., assists underinsured patients who have life-threatening chronic or rare diseases get access to medications and treatment by assisting with out-of-pocket costs. Dan Klein, the organization's president and chief executive officer, says he has noticed an uptick in the number of patients seeking PAN's help.

"One thing that worries me," Klein says, "is that Congress is very focused on lowering prescription drug prices. That's a good goal, but it's meaningless in an environment where patients still can't access care or medications because of their deductibles."

Susan resumed screenings this year. She says she did look into patient-assistance programs, such as the one offered by Right Action for Women, which helps individuals at high risk for breast cancer get access to MRI screenings. But she did not meet the criteria.

In preparation for her next scan, she has established a flexible spending arrangement at work and a health savings account so she can pay for at least some of her medical expenses from tax-free income. And she has been setting up payment plans with her health care providers. Still, concern over how she and her husband will pay for looming tests and treatment preoccupy the couple.

"After that first MRI bill, I wanted to give up," Susan says. "Because, in addition to dealing with the BRCA diagnosis, the insurance bills were overwhelming.

"I sometimes think about opting for surgery as a way to deal with my mutation," she adds. "But then I get nervous - because I'm afraid of the resulting bill from the hospital."

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The REAL truth is....both of the forum idiots are OWNED.
-BOTH of them have no clue who their owner is.
-They are both card carrying narcissists.
^These are PROVED facts.

Edited: 04/22/2019 at 12:49 PM by Fish Killer

Quite right. Health Insurance should be a full free market commodity priced to individual risk.

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They work for some people and don't with others. Depends on the individual's situation. I have a high deductible and it works well for me. The solution is to offer choices so that everyone can get what is best for their individual circumstances.

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I :heart; Q

Indeed. Let people buy what they can afford priced at market price based on their risk profile.

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Imagine if Republicans didn't do so much to oppose the legislation that was to help the working American. More than 20 states declined the Medicaid expansion and at the federal level they voted to destroy the ACA over and over to the total of more than 50 times.

Obama? Yea, right.

And didn't Obamacare try to do away with the max out of pocket plans and didn't Trump bring them back?

P.S. My HSA plan from the multi billion dollar corporation I used to work for had a high deductible coupled with $12,000 out of pocket. I paid out more than $50,000 over a five year period and that plan didn't have shit to do with the ACA.

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I was right.

Edited: 04/23/2019 at 08:18 PM by Cole

Almost all large corporations followed the LEAD of ObamaCare.

MORON!

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The REAL truth is....both of the forum idiots are OWNED.
-BOTH of them have no clue who their owner is.
-They are both card carrying narcissists.
^These are PROVED facts.

It sure was nice that our R-led three branches of gov't tackled this issue back in 16-17....oh wait....

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QOP = Terrorists
FK = Gay

THIS now, I'm going to agree that overall the ACA turned out to be a mess...(shouldnt have been pushed through until they had more cooperation to sort out the finer details) BUT Republicans had Full control of all three branches and they still got NOTHING done, so people need to quit the "Thanks Obama" bullshit, because at this point, that's what it is..... quit pointing fingers of the past and figure out a way to solve problems in the present/future.

Well, life sucks and it has been proven over and over again to cause death.

Yes, medical "costs" are seemingly "out of hand", but then again, probably so is our general "out of shape" physical condition. Life is expensive. Get over it. Get good care, and pay for it or, get sick and die a miserable death. Well, not really but, , , ,

We easily bitch about the cost of a visit to the doctor but, we see nothing wrong with paying a multi $100 cell phone bill every month, or paying $2500 for a "Big Screen", or buying a new $50K pick-up truck. It's your choice. Choose wisely.

Oh, and yes, it may seem easy for me to talk this way about it because the VA provides free care to me. But, back in the day of "cheaper" employer medical insurance I paid up to $1200 a month for coverage for my wife and I. When she had her severe brain injury in 2012, just the bill from Holmes was $326,000 although I had already paid that years $2000 "out of pocket". My recent bone marrow/stem cell transplant at the VA was valued at $180,000, not counting the travel and hotel.

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Dora Hates You

Medical costs are not 'seemingly out of hand', they are way out of fucking hand. How do I know? When healthcare results in 60%+ of US bankruptcies, we have a fucking problem. This isn't rocket science...

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QOP = Terrorists
FK = Gay

The cost in the ER for a couple of stitches after a shark nipped my hand...$3,200.

There will never be a time that I will agree with that.

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I was right.

I totally agree with Cole and wtf but, as I inferred, we also need to get our personal "spending" priorities straight. Life is VERY expensive and we should not want somebody else to pay for it. Triple or quadruple the Medicare payroll tax, then let's talk about "Medicare for all". The "basic" costs of care is a whole nudder story.

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Dora Hates You

Life is 'less expensive' in places like Germany where premiums are a percentage of income. So if you make more you pay more. If you make less you pay less. I pay over 13k a year with a 5k deductible. That's fucked.

We can fun medicare for all by making the world's biggest companies like Amazon and GE pay some fucking taxes.


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QOP = Terrorists
FK = Gay

I was never a fan of it, always preferred Obama's original proposal that included a public option. The insurance industry got their way with rewriting it when a few democrats, in the pockets of the insurance lobby, held out their votes.

How can we be sure the ACA was a failure when it was almost entirely sabotaged by the GOP blocking the implementation (especially here in FL), and now undermined by Trump' executive orders? Due to Rick Scott's antics, the federal funds for Medicaid expansion didn't arrive until the end of 2016. And had to pass through privatized disbursements first.

100% - good post.


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QOP = Terrorists
FK = Gay