Coming Healthcare Dilemma: High Deductibles and Short Turnaround for Coming Year

Citizen Wealth Financial Justice Health Care

Rising Cost of HealthcareMontreal          Having felt like a voice in the wilderness raging at these high deductible plans that through some kind of loophole or chicanery have managed to be seen as qualified and acceptable under the Affordable Care Act in the US, it’s absolutely no comfort to stumble onto news’ reports that acknowledge that this has largely been something of a hush-hush, dirty little secret observed by many.   Remember the basics:  if an employer’s plan has a monthly premium that is less 9% of gross income, regardless of the size of the deductible and it has the other mandatory features like annual physicals and so forth, according to the regs, it’s good to go.

Lower waged workers in nursing homes, community mental health facilities, and countless other jobs are finding themselves strapped with plans with huge $5000 and $6000 deductibles before they get any benefit of health insurance, making the plan something more akin to catastrophic coverage.  In Massachusetts there were limits at only a couple of grand, but not so on the federal level.   Also, keep in mind that if the employer has one of these sorry-ass plans that means that an individual or a family cannot receive subsidies or cost sharing in the marketplace, though they can pay top dollar if they can find something better.

Turns out it is not just lower waged workers represented by Local 100.

Next year, nearly a third of large employers will offer only high-deductible plans — up from 22 percent in 2014 and 10 percent in 2010, according to a study by the National Business Group on Health, which included 136 large companies that collectively employ 7.5 million workers. And 81 percent of those large employers will have added one of these plans to their lineup of choices, up from 53 percent in 2010.

One-third?  Holy-moly!  It’s a predatory corporate Ebola, and its spreading!

Some observers, trying to put a coat of paint on this rotting healthcare structure argue that some of these big whoop employers also have health savings accounts to help their workers’ pay out some of the sky-high deductible costs.  But, that’s not pretty either, and, personally I’m skeptical of estimates that 20% of the covered workers have such savings plans.

Given the increased adoption of the plans — Kaiser estimates about 20 percent of workers covered by plans were enrolled in a high-deductible plan with a savings account option in 2013, up from 8 percent in 2009 — consumers will need to weigh their options more closely during open-enrollment season.  “Understanding the mechanics of these plans is really important,” Mr. Marcotte said. “When you walk into the pharmacy and all of a sudden it costs $200 as opposed to $20, there is sticker shock.”

We are a couple of months from the renewal and enrollment window under ACA for 2015, but it’s only a narrow slit of time for people to shop around and figure out what to do, especially for renewals who will only have between November 15th and December 15th.  Trust me, this is going to be a madhouse on every level coupled with new navigation contracts, additional certification requirements –and delays – for navigators both old and new, and a ton of folks trying to get on the train for the first time as penalties increase.

For workers with high deductible plans leaving them with next to no health coverage, it’s small comfort that folks other than organizers and union representatives are tearing their hair.   The New York Times found me a fellow traveler at Harvard School of Public Health of all places:

Many workers may not have a choice — a high-deductible plan may be their only option. “If the deductible is very high, all of a sudden the financial protection part of insurance, you are losing that,” Professor Ginsburg said. “You still have protection against very high claims, but you have people who may have to pay $5,000 during one year toward the cost of their care or more. And a lot of people don’t have that kind of savings.”

Unfortunately this wider recognition is only helpful in the “misery loves company” sense, because none of these complaints seem to be raising the call for reform which is desperately needed.


Please enjoy Forgotten Man by Tom Petty and the Heartbreakers, thanks to KABF.