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Coverage That Kills – Breast Cancer Care Is Undermined By High Deductible Health Plans

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There are so many awful things about breast cancer. Here are two of them. (1) Receiving a diagnosis when your cancer is already advanced; (2) Not having enough money to pay for your treatment. 

 

Here is an awful thing about high deductible health plans: They delay breast cancer diagnosis and get in the way of proper breast cancer care. 

 

We should all be bothered by high deductible health plans. For starters, the deductibles are often too high. For individual coverage, it’s increasingly common for people to face deductibles of $2,000 or more. For families, deductibles can exceed $6,000. To make matters worse, high deductible plans often burden people with other out-of-pocket. Add in these copays, and a family could face more than $13,000 of out of pocket expenses on top of their insurance premiums. 

 

Another thing that bothers me: rebranding high deductible health plans as CDHPs or “Consumer Directed Health Plans.” This name does have the advantage of reminding us that deductibles aren’t the only out-of-pocket expenses people need to pay attention to. But so would the name “High Out-of-Pocket Health Plan” or (I just made this up) HOOPH! But the term CDHP was not created to better inform people about their out of pocket expenses but, rather, to convince us that high out-of-pocket expenses empower patients to act like savvy consumers of healthcare.  


But, of course, there is nothing empowering about being financially crippled by healthcare expenses. Instead, when people face high out-of-pocket expenses, they are often forced to decide whether they can afford important medical care.  


Consider what happened to a group of low-income women whose employers switched to high deductible health plans. (For the purposes of the analysisthe researchers defined low-income employees as those who lived in neighborhoods where at least 20% of families had incomes below the federal poverty level.) Low-income women in high deductible plans were less likely to receive tests to determine whether they had breast cancer. They were even less likely to receive breast cancer chemotherapy. Here’s a picture of that latter result, showing rates of chemotherapy for low-income women in high deductible health plans (“switched women”) vs. income-matched controls who had low deductible plans (“matched women”):  

 

  

Employers need to get rid of high deductible health plans. Yesterday! They need to turn to smarter alternatives, especially for lower-income employees who can’t be expected to stash thousands of dollars away in savings accounts to pay for chemotherapy.

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