High-Deductible Coverage and the Underinsured: The Next Healthcare Crisis?

Are the underinsured the next healthcare crisis?  That's the question posed by John Commins for HealthLeaders Media (May 21, 2015): Underinsured May be the Next Healthcare Crisis.

President of the Commonwealth Fund, David Blumenthal, MD has some interesting observations of the high-deductible plans being used to expand coverage to millions of Americans who otherwise could not afford coverage:

"The financial health insecurity that comes from being underinsured is substantial and puts people's health and well-being at risk."

And a report co-authored by Sara Collins and others for the Commonwealth Fund found that 31 million adults ages 19-64 with health coverage were under-insured in 2014.

"Someone is underinsured if their out-of-pocket costs excluding premiums over the 12 prior months are equal to 10% or more of household income," Collins says, "or if their out-of-pocket costs excluding premiums are equal to 5% or more of household income if their income is under 200% of the federal poverty level, which is about $23,000 for an individual and $47,000 for a family of four, of if their deductible is 5% or more of household income."

As premiums increase, deductibles increase, and healthcare costs increase, the under-insured fall deeper into the healthcare affordability hole.

Former insurance executive Wendell Potter is quoted as saying that high-deductible plans are a windfall for commercial insurance providers. "To them right now this is an ideal scenario," Potter says. "They are collecting premiums, which continue to go up every year, but every year they are shifting more of the costs to the consumers."

The Commonwealth Fund report's findings are in line with a Families USA report this month which also found that that one-in-four people who bought non-group health insurance in 2014 went without needed care because they couldn't afford it. That report blamed deductibles of $1,500 or more as the leading cause for the skipped care.

The consequences of this are the under-insured postpone healthcare when they need it or delay filling prescriptions and avoiding preventative care tests and strategies.

What are you seeing at your hospital?  How prevalent are high-deductible plans and how often do we see these under-insured arriving at ER rather than for elective tests and procedures?