Keeping the Needs of Consumers Front and Center at the High Deductible Health Plan Task Force

By Jill Zorn |

At the November 13 meeting of the High Deductible Health Plan (HDHP) Task Force, members heard a presentation about how HDHPs have done nothing to lower prices and have had a negative impact on both consumers and employers.

James Stirling, CEO of Stirling Benefits, emphasized how, in an effort to keep premiums lower, costs are simply being shifted onto patients.  This short-term thinking is leading to people putting off care – causing avoidable health problems down the road.  Meanwhile, this cost shift doesn’t seem to be leading to lower premiums.  Health care prices are continuing to go up, so premiums, too, are continuing to rise right alongside growing out-of-pocket costs.

An interesting slide in the presentation came early on in the presentation.  It showed a pyramid where, at the very top, 2% of people have catastrophic, expensive health problems.  These 2% are actually responsible for fully half of all costs.  Then there are another 25% who live with chronic illnesses such as diabetes, high blood pressure and asthma.  That leaves approximately 78% of people who are less affected by HDHPs, because they don’t use their health insurance very much.

The pyramid illustrates just why insurance is needed.  Healthy people pay into a pool so that people with health problems can get care.  They also pay in so that when they take a bad fall, come down with a serious illness or develop a chronic condition, they will have access to care, too.

Yet HDHPs are turning this system upside down. Now, when people get sick, they can’t afford to get the care they need.  In fact, they feel uninsured.

Stirling also spoke about the challenge employers face to purchase insurance that truly covers their employees’ health needs.  More and more, they find HDHPs are their only option.  And still their premiums continue to rise.

In closing, Stirling shared his ideas about what would work better.  It was striking that the first item on his list of recommendations was: “Reduce or eliminate high deductibles”.  He then emphasized the need for a system that promotes primary care and makes it easier for people with chronic illness to get the care they need.  He would like to see incentives move in the right direction: to promote lower costs and better quality.

The panel also heard a presentation from the American Bankers Association about Health Savings Accounts.

The meeting opened with public comment from our foundation.  I provided an update about an issue raised in the previous task force meeting by Dr. Victor Villagra of the Health Disparities Institute. As was discussed in our previous blog about the HDHP task force, his presentation  highlighted the aggressive collection practices of Danbury Hospital.  This problem received some much-needed sunlight via an article in the Danbury News Times.  A follow-up article reports that the hospital has announced they will be changing their policy, to “be more empathetic to our patients.”

I also shared a story from Allyson, a Licensed Professional Counselor, who struggles to afford the treatment she needs, given that she has a high deductible health plan.  Allyson also surveyed others who work in her profession.  They all report that HDHPs throw up many hurdles for their patients, who end up cutting therapy short or seeing their counselor less frequently.

Our comment closed with this concern:

“The membership of this task force is dominated by providers and insurers.  While I believe we all agree that high deductible health plans are far from ideal, it is not useful for providers and insurers to simply point fingers at each other, as I saw occurring at the previous task force meeting.  The people of Connecticut are relying on you to have a constructive conversation, not a discussion focused on defending your specific profession or industry or accusing the other.

“Please remember Allyson and her colleagues, who highlighted the harm being done to their patients.  If we are going to do something about high deductible health plans, everyone is going to have to give a little.  And we’re going to need to keep the needs of patients and consumers front and center.”

The next meeting of the task force will be December 4.  The majority of the meeting will be devoted to a discussion among the members about their knowledge about HDHPs, what has been learned so far and how to begin to formulate recommendations.  Given the makeup of the group and the short time frame they face to reach some agreement on recommendations, it will be important for task force members to approach this task constructively, keeping the needs of patients and consumers “front and center.”