High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates From the National Health Interview Survey, 2016
By Robin A. Cohen, Ph.D., and Emily P. Zammitti, M.P.H.
National Center for Health Statistics, June 2017
This report provides recent estimates from the National Health Interview Survey (NHIS) for the percentage of privately insured adults aged 18–64 who experienced financial barriers to care in the past 12 months by source (employment-based or directly purchased) and type (traditional or HDHP) of private coverage. Because income is also associated with financial barriers to care, income distribution by source and type of private coverage is also shown. All estimates in this report are based on preliminary data.
* The percentage of adults aged 18–64 with employment-based coverage enrolled in a high- deductible health plan (HDHP) increased, from 26.3% in 2011 to 39.3% in 2016.
* In 2016, among privately insured adults aged 18–64 with employment-based coverage, those enrolled in an HDHP were more likely to experience the two financial barriers to care analyzed in this report than those enrolled in a traditional plan.
* In 2016, among privately insured adults aged 18–64 with directly purchased coverage, the percentage of those who had experienced financial barriers to health care did not differ by type of coverage (HDHP or traditional).
* In 2016, among privately insured adults aged 18–64 with employment-based coverage, income distributions were similar between those with an HDHP and those with a traditional plan.
* In 2016, among privately insured adults aged 18–64 with directly purchased coverage, those enrolled in an HDHP had higher household incomes than those enrolled in a traditional plan.
Figure 3. Percentage of privately insured adults aged 18–64 in families having problems paying medical bills in the past 12 months, by source and type of private coverage: United States, 2016
9.0% – Traditional coverage
15.4% – High deductible health plan
15.9% – Traditional coverage
16.1% – High deductible health plan
Figure 4. Percentage of privately insured adults aged 18–64 who did not get or delayed medical care due to cost in the past 12 months, by source and type of private coverage: United States, 2016
4.1% – Traditional coverage
8.5% – High deductible health plan
11.8% – Traditional coverage
13.3% – High deductible health plan
From the Summary
Among privately insured adults aged 18–64 with employment-based coverage, those enrolled in an HDHP were more likely than those enrolled in a traditional plan to forgo or delay medical care and to be in a family having problems paying medical bills. However, among privately insured adults aged 18–64 with directly purchased coverage, the pattern of results was different. In 2016, there was no significant difference in financial barriers to health care according to type of plan (traditional or HDHP) in the direct purchase market.
By Don McCanne, M.D.
Without getting bogged down in numbers (and there are many more in the full report), what can we glean from the facts here?
A significant percentage of privately insured families have problems paying medical bills or do not get medical care due to cost, regardless of whether their coverage was through a traditional plan or through a high deductible health plan, and regardless of whether their insurance was employment based or purchased directly in the individual insurance market. Private insurance is not providing adequate protection for too many individuals and their families.
Employment based coverage is shifting from traditional plans to high deductible health plans. Those in high deductible employment based plans are having more difficulties paying medical bills or obtaining care than are those still enrolled in traditional health plans. This shift to high deductible health plans has had an adverse financial impact on employees and their families.
For those who purchase their health care coverage directly in the individual market rather than obtaining it through their employment, those who select a high deductible health plan have higher incomes than do those who select a traditional plan. This is consistent with the well established observation that high deductible health plans are appealing to the healthy and wealthy, especially when linked to health savings accounts.
The authors of this report note that, for those purchasing their coverage directly in the market, there was no difference in encountering financial barriers to care for those selecting a high deductible plan versus those selecting a traditional plan. Though those with lower incomes who selected traditional plans fared as well as those with higher incomes who selected high deductible plans, that is not saying much. It would be more informative to state that those who selected traditional plans in the individual market fared as poorly as those selecting high deductible plans in that market. This is in contradistinction to employer based plans. In sum, traditional plans offered by employers provide better protection that do their high deductible plans, but traditional plans in the private market provided protection that was as lousy as the high deductible plans in the private market.
This is not meant to be an endorsement of employer sponsored traditional plans since too many people still face problems with medical bills and financial barriers with these plans. But this is a condemnation of the direction in which we are headed – greater use of high deductible health plans which are creating even greater personal financial hardships.
The more important message here is that the very best of private plans available – the employer sponsored traditional plans – though better than high deductible plans, are still not good enough. A well designed single payer program – an improved Medicare for All – would remove these financial barriers so that all of us can receive the care we need regardless of our individual incomes or wealth.