As employers increasingly turn to high-deductible health plans to keep premium increases in check and encourage people to be more selective about their healthcare spending, the practice raises questions about the effect such plans have on different demographics.
In fact, a new study published in Health Affairs found that among those with employer-sponsored insurance plans, the burden of high-deductible plans was significantly higher on low-income individuals than those with middle or high incomes. The researchers found that low-income individuals were more likely to spend 20% or more of their after-tax income while enrolled in any type of employer-sponsored health plan—even those without a deductible at all.
In addition, low-income individuals enrolled in high-deductible plans paired with health savings accounts (HSAs) spent nearly 30% of their after-tax income on healthcare, according to the study. Comparatively, high-income individuals with similar plans spent less than 5% of their after-tax income on healthcare.
The study assessed data from Medical Expenditure Panel Surveys from 2011 to 2013, before much of the ACA went into effect. While ACA provisions like marketplace subsidies and Medicaid expansion might lead to some improvements, "for most low-income enrollees of employer-sponsored plans, high burden rates are likely to persist past 2014," the researchers note.
Indeed, deductibles for employer-sponsored plans rose 12% between 2015 and 2016, even as premiums for such plans have grown only modestly.
The study also assessed the role of employer contributions to HSAs, and found that the share of income spent on care dropped from 30% to 26.8% for low-income individuals with high-deductible plans when employers contributed about $1,200 to the accounts.
Yet high-deductible plans linked to HSAs may do little to help patients with chronic conditions, as IRS rules say that they only cover certain preventive services if patients buy enough services on their own to pay down their deductible.