Aug 14, 2017

What people think of high deductibles — and what surveys don’t tell you

We got a lot of feedback on an item last week about the premiums and deductibles in employer-sponsored health plans — the two kinds of health costs most of us face. It's clear that more people are facing high deductibles, and a lot of people don't like them, for obvious reasons: No one wants to pay more out of pocket when they have urgent medical needs.

Deeper dive: Turns out, though, that they're not as unpopular as they used to be. The Employee Benefit Research Institute has been conducting surveys of employees' attitudes toward high deductibles for about a decade. Those kinds of health plans are still less popular than traditional kinds of health plans, like PPOs and HMOs — but the margin isn't as lopsided as it was a decade ago.

Note: High-deductible and consumer-driven plans both have high deductibles. CDHP plans include a health savings account or reimbursement arrangement. HDHP plans do not;

Data: Employee Benefit Research Institute; Chart: Chris Canipe / Axios

Here's what the surveys have found:

  • Traditional health plans are still the most popular kind of employer health insurance.
  • Employees have grown more satisfied over time with high-deductible health plans and consumer-driven health plans. (In the surveys, a CDHP could be paired with either a health savings account or a health reimbursement arrangement, while a HDHP wouldn't have either one, according to EBRI's Paul Fronstin.)
  • The gap is closing, and they're clearly not as unpopular as they were in 2005.
  • But both kinds of high deductible plans are still below 50% percent satisfaction rates — meaning there's a substantial number of employees who don't like them.

Between the lines: Fronstin says the differences could be due to the "80-20" rule — 20 percent of people account for 80 percent of health care spending. If they're in that group, they're spending the whole deductible, and are understandably upset. If not, the deductible may not matter as much because they're not using it.

Yes, but: Here's one situation you won't find in any of the surveys about employer-sponsored health care: They don't account for people who have been forced to switch health plans. That's what happened to a reader I heard from last week, who had to switch from an HMO to a high-deductible health plan — with much higher out-of-pocket expenses — because the company changed plans.

We have a pretty good idea of what the national averages are, thanks to the Kaiser Family Foundation surveys on premium and deductible growth in workplace health plans. What that doesn't tell you, though, is how many employees had to switch from one kind of plan to another — increasing their costs because of it — and why. And, of course, how they felt about it.

The bottom line: I couldn't find anyone who had done that kind of survey, and it would be a good one for someone to do. In the meantime, we should all remember that we don't know everything about how changes in health care — whether because of policy changes or because employers just want to cut their costs — are affecting people's lives. There's a lot that we're probably missing.

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