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High-Deductible Health Plans


The uptake of high-deductible health plans (HDHPs) has accelerated with the state and federal health exchanges under Obamacare. The out-of-pocket costs of these plans, including premium payments, are “consuming far more of total family income than is reasonable,” says Francois de Brantes, executive director of the Healthcare Incentives Improvement. A dilemma, he comments, is that HDHPs are the only way to get premiums down to a level of affordability for many individuals. He believes that until the industry is fully transformed, “It’s not going to get better.”

“It is popular to argue against mandates of any kind,” stresses Arthur Vercillo, MD, FACS, regional president of Excellus Blue Cross Blue Shield, but he strongly recommends that the premiums people pay buy them what amounts to some real insurance—a meaningful minimum benefit package that insurance covers.

Affordability is the key issue, reiterates Mr de Brantes. If the premiums and out-of-pocket costs are 20 to 30% of family income, that’s not affordable or workable.

Large out-of-pocket costs can have negative health consequences, acknowledges Ateev Mehrotra, MD, MPH, associate professor of healthcare policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center. This is especially true for the poor, the elderly, and those with chronic illnesses. In addition, prices for care vary greatly and prospective patients need much more information and transparency about medical care pricing if they are to make intelligent decisions regarding their out-of-pocket costs.

One added advantage that is often overlooked, points out Dr Vercillo, is that when an individual is insured by an exchange plan, they are already getting a negotiated rate for care that is substantially better than what someone without insurance might have to pay.

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