HARTFORD, CT — A task force focused on high-deductible health plans got to work Wednesday to tackle the issue, which they quickly discovered was more complicated than they initially thought.
“Premiums and deductibles are a reflection of healthcare costs,” Susan Halpin, a member of the task force and a lobbyist for the health insurance industry, said.
She said if you start to reduce the deductible the monthly premiums will continue to rise, adding that deductible plans have shined a light on the cost of care and whether it’s appropriate. Generally, the idea behind these high-deductible plans is to get consumers to take a closer look at how much things costs and to shop around for services.
However, according to studies done on the subject, that’s not what’s happening.
The National Bureau of Economic Research studied 50,000 non-emergency, outpatient MRIs on lower limbs. It found that only 1% of the patients used a price-comparison tool to shop for an MRI before receiving one, and the rest got their MRI wherever their doctor advised.
Lynne Ide, director of program and policy for the Universal Health Care Foundation, said a 2019 Benchmark Employer Health Benefits Survey found a 162% increase in deductible costs over the past 10 years.
New numbers from the 2018 US Medical Expenditure Panel Survey found that high deductible plans covered 63% of Connecticut residents with single plans and 55% of families last year. The number of Connecticut workers in high-deductible health plans grew from 2017 to 2018.
Joseph McDonagh, an insurance agent and member of the task force, said he’s probably an outlier because he doesn’t believe there’s much they can do to impact the current marketplace.
He said in 2015 there was only one plan offered on Connecticut’s health insurance exchange that didn’t have a deductible. In 2019, every plan offered on the exchange had a deductible.
He said the deductible in 2019 for a silver plan is 50% more than the deductible for that same plan four years ago. The out-of-pocket costs for those same plans have gone up by 30%.
McDonagh said the other trend he’s seen over the past few years are changes to what health care services apply to the deductible. He said specialists and emergency room visits are subject now to the deductible before they revert to a co-pay.
He said the task force might want to look at how the deductibles are applied and where they are applied.
“There are perhaps some things nibbling around the edges that we might be able to accomplish,” McDonagh said.
Halpin warned that any proposals the task force makes will only impact 35% of the marketplace because that’s all that falls under the control of the state legislature and Insurance Department.
Self-insured plans offered by employers are governed by federal law.
Healthcare Advocate Ted Doolittle, who is chairing the task force, said he believes high-deductible plans have their place in the market.
Dr. Andrew Wormser, the past president of the Connecticut Society of Internal Medicine, said there’s an existential question about whether deductibles should exist in a health insurance market because “they’re a very harsh method of cost-sharing and they’re regressive.”
He said he’s “horrified at the way the incentives for healthcare change with the dates on the calendar.” He said deductibles push care off until the end of the year when people may have met them.
“Something we should explore, in my opinion, is no deductibles,” Wormser said.
Doolittle said the existence of the high-deductible task force puts Connecticut out front on the issue because there isn’t any other state studying these plans.
“It is a complicated issue and maybe that’s why it hasn’t been tackled,” Doolittle said.
He said he hopes the task force can come forward with some creative solutions by February when their report is due to the legislature’s Insurance and Real Estate Committee.