When High Deductibles Hurt: Even Insured Patients Postpone Care -AND- With Tom Price in charge at the Department of Health and Human Services, doctors are winning in Washington

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Thu Aug 3 15:25:35 PDT 2017



July 27, 2017


When High Deductibles Hurt: Even Insured Patients Postpone Care 



d-patients-postpone-care/> California Healthline



By Pauline Bartolone 


In November 2015, Tina Heck was in her garage lifting 40-pound bags of wood
pellets to fuel her heating stove, when something went very wrong with her


"The next day, I could barely walk," said the 55-year-old who lives on an
acre of land in Nevada City, Calif., 60 miles northeast of Sacramento. The
cause: a bulging disc in her lower spine, which shoots pain down her leg and
makes her back stiff.


The injury wasn't Heck's only setback. The initial MRI, cortisone shot and
doctor visit cost her $3,000 because her health plan requires her to shell
out $5,000 before insurer payments kick in. She doesn't want to explore
other treatment options because of that high deductible. Heck, who makes
$68,000 a year in marketing for a nonprofit, is not willing to add more debt
on top of her credit-card and mortgage payments.


"I'm in pain every day," she said, but "it's not bad enough to go into


The concept behind high-deductible plans was to lower premiums and reduce
overall health costs by ensuring that consumers shared the financial burden
of their own health care decisions. But evidence is mounting: High
deductibles have actually forced people to delay care that could prevent
health emergencies later or improve their quality of life.


Regardless of what happens to the Affordable Care Act, such plans are likely
to become more widespread as health care costs continue to rise. Just over
half of people with health plans from their employers now have a deductible
of $1,000 or more, up from 10% in 2006, according to the Kaiser Family
Foundation. (Kaiser Health News, which produces California Healthline, is an
editorially independent program of the foundation.)


"People who have medical problems that can be put off tend to do so much
more now because of the high deductible," said Dr. Ted Mazer, a San-Diego
based head and neck surgeon who is president-elect of the California Medical


Annual deductibles can amount to many thousands of dollars on some plans.
Covered California bronze plans, with the lowest premiums available on the
exchange, carry deductibles of $6,300 for an individual and $12,600 for a


A Kaiser Family Foundation survey released this year showed that 43% of
insured people reported having trouble paying their deductible, up from 34%
in 2015.


In one study by the liberal advocacy group Families USA, more than a quarter
of people in high-deductible plans delayed some type of medical service such
as a doctor visit or diagnostic test. And 44% of adults with high
out-of-pocket expenses put off medical care, according to a nonpartisan
Commonwealth Fund study.


Another recent study by researchers at the University of California-Berkeley
and Harvard University found that people with high-deductible plans spent
42% less on health care before meeting their deductibles, primarily by
reducing the amount of health care they received, not by shopping around for
a better price.


Jonathan Kolstad, associate professor of economics at UC-Berkeley's business
school and co-author of the study, said patients dropped both needed care,
such as diabetes medication, and potentially unnecessary care, such as
imaging for headaches.


"Left to their own devices, people [in high-deductible plans] seem
ill-equipped to make their own decisions" about what care they need, and
what care they don't, Kolstad said.


Mazer said that, in his practice, people have delayed all kinds of treatment
that may not save "life or limb" but involved medical conditions that
interfered with breathing or sleeping.


He said he's had patients who needed a biopsy to determine if an abnormal
vocal cord was cancerous, and they put it off because of the cost.


"I have to make the phone call and say, 'We're looking at a mass that may be
malignant and if you put it off you're putting yourself at risk,' " Mazer
said. "And I'll tell you, we've had people take that risk."


Recent Republican proposals to repeal Obamacare have promoted the use of
high-deductible plans by allowing people to put away more tax-free dollars
into the health savings accounts that consumers use in conjunction with
those plans. And experts said the proposals would also spur the growth of
these plans - by cutting the subsidies available through exchanges, inducing
customers to look for cheaper plans with higher deductibles.


Conservatives say insurance that promotes personal financial responsibility
helps tamp down overall health costs. Hoover Institution analysts, for
example, argue that high deductibles encourage patients to "choose wisely."


But new evidence suggests that putting off care can be dangerous and,
eventually, more costly to patients.


A March 2017 Harvard study found that low-income patients with diabetes who
had high-deductible plans delayed visits for complications such as skin
infections and pneumonia. They wound up getting more expensive care later


Patients may try to treat their conditions at home, or hope they go away -
but if that approach fails, "they then have to seek care at the emergency
department," said Frank Wharam, a health policy researcher at Harvard
Medical School and lead author of the study.


Wharam said the middle-income earners he studied didn't suffer any adverse
effects from health care choices they made in high-deductible plans, adding
that more studies are needed on that group.


Sabrina Corlette, from the Georgetown University Center on Health Insurance
Reforms, said that until national health policy addresses the "underlying
costs of care," patients in high-deductible plans will likely be stuck with
the difficult task of figuring out what medical attention they need or can


Heck said the symptoms from her back injury have changed - the pain is in a
different part of the body than it was right after the injury. But she's not
even considering a trip to a nearby clinic for a new assessment. That would
require another MRI, she said, which could cost at least $1,500, and it
might not even help her. If her deductible weren't as high, she'd feel
"freer" to explore other health care options, she said.


For now, she's taking a lot of ibuprofen and seeing a chiropractor.


"A lot of people get stuck in this place," she said.




August 1, 2017


With Tom Price in charge at the Department of Health and Human Services,
doctors are winning in Washington



Zk1WeSJ9> Fierce Healthcare



By Joanne Finnegan


When Tom Price, an orthopedic surgeon, was named secretary of Health and
Human Services earlier this year, doctors had high hopes that he would look
out for their interests. That's exactly what's happening: With Price in
charge at HHS, doctors are winning in Washington.


While the fight over the repeal of the Affordable Care Act has raged loudly
and publicly in Washington, Price has been working quietly to reverse other
Obama administration efforts, acting to protect doctors from regulations put
in place in the prior eight years, according to STAT.


Price is listening to physicians' concerns about issues such as Medicare
payment rules under MACRA and burdensome electronic health record
requirements, STAT said.


Among the actions he has taken:


*  An American Medical Association committee was given more power over how
much the federal government pays for different medical services.

*  He has retroactively reversed certain Medicare rules to ensure some
physicians no longer face penalties they would otherwise have had to pay.

*  Price has proposed using almost $1 billion in savings that would be
achieved through cuts to certain hospital payments to boost spending on


While many doctors vehemently oppose Republican efforts to repeal the ACA,
they are thrilled at the regulatory rollbacks.


Hospitals, however, haven't fared as well, with a proposal that would result
in major cuts to hospital payments. A proposed Outpatient Prospective
Payment rule, released in July, would significantly cut 340 billion drug
discount payment rates to hospitals and may harm safety-net hospitals'
ability to treat low-income patients.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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