The High Deductible Health Plan Task Force Heard From Experts | They Need to Hear From You, Too!
by Jill Zorn
At the November 6 meeting of the High Deductible Health Plan (HDHP) Task Force two experts gave presentations that focused on how the harms caused by HDHPs far outweigh any possible benefits they may provide.
The speakers were Victor Villagra, MD, of UConn’s Health Disparities Institute and Lynn Quincy, from Altarum’s Healthcare Value Hub. They emphasized that HDHPs are hazardous to people’s physical and financial health.
Health Harms of HDHPs
The evidence is clear that when confronted with the possibility of high out-of-pocket costs, people may reduce unnecessary or low–value care that they wouldn’t benefit from. But they are just as likely, if not more likely, to forgo care that they really need.
The speakers cited studies that showed that out-of-pocket costs led people with high cholesterol, high blood pressure or cancer to delay or avoid care. A poll conducted by the Healthcare Value Hub in Connecticut showed that 43% of those surveyed said they delayed or completely avoided getting care due to cost concerns. And 20% reported they did not fill their prescriptions at all, or skipped or reduced doses.
Financial Harms of HDHPs
Not only are HDHPs keeping people from getting the care they need, they are putting people at great financial risk. The Healthcare Value Hub survey tells the story: 24% of those surveyed reported struggling to pay a medical bill received in the last year, including one or more of the following challenges:
- Being sent to collections
- Using up all or most of their savings
- Racking up large amounts of credit card debt
- Being unable to pay for basic necessities like housing, food or heat because of high medical bills
Providers are being caught in the middle-choosing when to write-off bills and whether to sue their patients in order to be paid. Media accounts are coming out almost daily about hospitals following aggressive collection practices against their patients, even against their own employees.
Hospitals and physician practices in Connecticut are responding to this challenge in different ways. The Health Disparities Institute reported that an analysis of 2016 medical debt small claims court cases found one hospital, Danbury Hospital was responsible for nearly half of all cases. While the number of overall cases dropped from 2014 to 2016, likely due to the expansion of insurance coverage under the Affordable Care Act (ACA), there are indications that the medical debt problem is growing again in Connecticut. In 2018, as reported at the November Health Care Cabinet meeting, Connecticut hospitals saw a 16% increase in bad debt, the first major increase in several years.
Another option for at least those hospitals with strong market power, is to raise the prices they charge patients covered by private insurance, to try to make up for uncollected fees. In fact, Connecticut hospital revenues and profit margins were up in 2018, with revenues rising faster than expenses.
The experts proposed solutions — including getting rid of HDHPs all together. But it will take bold action on behalf of the needs of every-day people in Connecticut to stop the ever-worsening cycle of higher prices, avoided care, unpaid bills and financial ruin for patients.
While it is a positive step that the legislature has convened the HDHP task force, there are no guarantees that progress will be made. At the most recent meeting it was discouraging to see task force members, representing the insurance industry and providers, point their fingers at each other across the table. As the experts presented their findings on the harm caused by HDHPs, each accused the other of bad faith and of making things worse. Yet, in the end, it is consumers — who have the least ability to absorb financial hits, and who, by the way, barely have representation on the task force — who are being hurt the most.
That is why the task force needs to hear from you. Please share your high deductible health plan horror stories with us by filling out this form and we will pass them along in our public comment at the next meeting. Or better yet, show up in person to tell your story and demand action.
The High Deductible Health Plan Task Force is meeting at the Legislative Office Building, 300 Capitol Avenue in Hartford from 11am to 1pm on the following dates: November 20, December 4 and December 18, 2019. Each meeting opens with an opportunity for public comment.
To see the presentation slides referred to in this blog, go to the November 6, 2019 section on the HDHP Task Force web site to view their presentations.
The presentations can also be viewed “on demand” on CT-N by going here.
Health Care Cabinet Presentation on Hospital Financial Status