Republicans push high deductible plans and health savings accounts : Shots

Sarah Monroe once led a relatively comfortable middle-class life.

She and her family lived in a well-kept neighborhood near Cleveland. Thanks to her work, they had a six-figure income and health insurance. Then, four years ago, when Monroe was pregnant with twin girls, something started to go wrong.

“I kept having to go to the emergency room for fainting and other symptoms,” recalls Monroe, 43, who works for an insurance company.

The babies were fine. But after months of tests and trips to the hospital, Monroe was diagnosed with a potentially dangerous heart condition.

It will be expensive. Within a year, juggling a serious illness and a pair of newborns, Monroe was buried under more than $13,000 in medical debt.

One reason: Like tens of millions of Americans, she had a high-deductible health insurance plan. People with these plans typically pay thousands of dollars out of pocket before coverage kicks in.

Plans that exist become ordinary have received increased attention over the past two decades thanks to President Donald Trump and his GOP allies in Congress.

Many Republicans are reluctant to expand government subsidies that help cover patients' medical bills and insurance premiums under the Affordable Care Act.

And while GOP leaders have yet to unite around an alternative, several leading Republican lawmakers have proposed that Americans who don't get insurance through an employer get cash from a special health account paired with a high-deductible health plan.

Under this arrangement, someone could choose a plan from the ACA marketplace that costs less per month but includes annual deductible this can exceed $7,000 on an individual plan.

“The patient makes the decision,” said Sen. Bill Cassidy, R-Louisiana. at a recent hearing. “This gives the patient the opportunity to reduce the cost.”

IN post to Truth Social Last month, Trump said: “The only health care I will support or approve of is sending money directly to people.”

“Skin in the game”

Conservative economists and GOP lawmakers make similar arguments since high-deductible health insurance plans began gaining popularity two decades ago.

At the time, backlash against the restrictions of HMOs or health maintenance organizations prompted many employers to enroll workers in these plans, which were supposed to empower patients and control costs. A tax law change allowed patients enrolled in these plans to put money into tax-free health savings accounts to cover medical bills.

“The idea was that if a consumer has a 'chance in the game,' they are more likely to seek better, cheaper health care,” said Sean Gremminger, who heads the National Alliance of Health Care Buyer Coalitions, a nonprofit that works with employers who offer health benefits to their workers.

“Unfortunately, the reality is that in most cases this is not the case,” Gremminger said.

Today, almost all health insurance plans have a deductible. on average per employee with employment-based coverage approaching $1,700, up from about $300 in 2006.

Plans with a deductible greater than $1,650 can be combined with a tax-free health savings account.

But even as franchises have become widespread over the past 20 years, prices for health care in the United States have skyrocketed. The average price of a knee replacement, e.g. increased by 74% from 2003 to 2016, more than double the general inflation rate.

At the same time, patients are left with thousands of dollars in medical bills that they cannot pay despite having health insurance.

About 100 million people in the United States have some form of medical debt. 2022 survey showed.

Most of them, like Monroe, are insured.

Shopping for medical prices is not easy

Although Monroe had a health savings account combined with her high-deductible plan, she never managed to save more than a few thousand dollars, she said. It wasn't enough to cover the large bills when she had twins and when she became seriously ill.

“It’s impossible, I’ll tell you, it’s impossible to pay medical bills,” she said.

There was another problem with her high-deductible plan. Although these plans were intended to encourage patients to seek care at the lowest possible prices, Monroe found this impractical when she had a difficult pregnancy and heart problems.

Instead, Monroe chose the largest health care system in her area.

“I held that view regarding medical risk,” she said. “If anything happens, I can be transferred to this system.”

Federal rules requiring hospitals to publish more prices may make it easier than before to compare facilities.

But unlike a car or a computer, most health care services are still difficult to purchase, in part because they occur during an emergency or are complex and can stretch out over many years.

For example, researchers from the nonprofit Health Cost Institute estimate that only 7% The total portion of health care costs for Americans with job-based insurance was for services that could actually be purchased.

Fumiko Chino, an oncologist at MD Anderson Cancer Center in Houston, says it makes no sense to expect patients with cancer or other chronic disease to go out and compare prices for complex medical care such as surgery, radiation therapy or chemotherapy after they are diagnosed with a potentially fatal disease.

“You can't really do it effectively,” Cino said, “and certainly not in the time frame that you'll need to when you're faced with a cancer diagnosis and the inevitable need to start treatment.”

Drowning in bills

Cino said patients with high deductibles often instead face a flood of huge medical bills that lead to debt and a cascade of other problems.

She and other researchers found in study More than 8,000 cancer patients last year told the American Society of Clinical Oncology that cancer patients who had high-deductible health insurance were more likely to die than similar patients without such insurance.

For their part, Monroe and her family were forced to move out of the house and into an 1,100-square-foot apartment.

She has depleted her savings. Her credit rating dropped. And her car was taken away.

There were other victims. “When families get to have a good Christmas or go on spring break,” Monroe said, she often doesn't.

She is grateful that her children are healthy. And she continues to work. But Monroe said she can't imagine why anyone would want to double down on a high-deductible health care model.

“We have a responsibility to do this differently,” she said. “We can't treat people like that.”

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