Sarah Monroe used to enjoy a fairly stable middle-class existence. Living in a well-kept neighborhood near Cleveland, her family had a solid income and health insurance from her job. However, everything shifted about four years ago when she became pregnant with twins and began experiencing troubling symptoms.
“I had to rush to the emergency room because of fainting episodes and other issues,” Monroe, now 43 and employed at an insurance company, recalled.
The twins were healthy, but after months filled with tests and hospital visits, Monroe was diagnosed with a potentially serious heart condition.
This diagnosis came at a heavy financial cost. Within a single year, she accumulated over $13,000 in medical debt while juggling her serious health issues and caring for two newborns.
A part of the problem was that, similar to millions of Americans, she was enrolled in a high-deductible health plan. These types of plans often require individuals to pay thousands out-of-pocket before any insurance coverage kicks in.
These plans have become increasingly prevalent over the last twenty years, partly due to renewed interest from figures like former President Donald Trump and Congressional Republicans.
Many in the GOP hesitate to broaden government subsidies that could ease the financial burden on patients utilizing the Affordable Care Act (ACA).
While Republican leaders have yet to unite around a cohesive alternative, several prominent party members have suggested directing funds into health accounts for those who lack employer-based insurance, alongside high-deductible plans.
In such a setup, an individual might opt for a lower monthly payment plan through the ACA Marketplace, though high annual deductibles can exceed $7,000.
Sen. Bill Cassidy (R-Louisiana) stated during a public hearing, “The patient makes the decision,” advocating for this approach as a means for people to save money.
Trump recently emphasized his support for this perspective, declaring in a post that “the only health care that I support is sending money directly back to the people.”
“Skin in the game”
Conservative economists and Republican officials have been discussing such health plans since they gained popularity two decades ago. Initially prompted by frustrations with HMOs, employers transitioned to high-deductible plans in hopes of empowering patients and controlling costs.
Changes in tax legislation have enabled patients in these plans to contribute to tax-exempt health savings accounts for medical expenses.
Sean Gremminger of the National Health Care Purchasers Alliance noted that the idea was rooted in the belief that consumers with “skin in the game” would seek better-quality, more affordable care. However, he observed, “Unfortunately, this rarely happens.”
Almost every health insurance plan today features a deductible, which averages around $1,700 for a worker, compared to about $300 back in 2006. Plans with deductibles over $1,650 can be paired with tax-exempt health savings accounts.
Despite the surge in deductibles, healthcare costs have skyrocketed in America; for instance, the price of knee replacement surgery has seen a 74% increase between 2003 and 2016, outpacing overall inflation.
Many patients now face substantial medical bills even with insurance, with roughly 100 million Americans grappling with some form of medical debt.
Monroe, like many, had insurance but found herself struggling.
Navigating medical price shopping
Although Monroe had a health savings account linked to her high-deductible plan, she was unable to save more than a few thousand dollars. That simply wasn’t enough for the expensive care she needed during her pregnancy and subsequent health problems.
“It’s impossible to cover medical care costs,” she expressed.
Another drawback of her high-deductible insurance was that it was designed to promote price shopping, which she found unfeasible given her complicated medical situation.
Ultimately, she opted for the largest health system in her area, reasoning that it was safer due to the potential medical risks.
A federal regulation requiring hospitals to publicly display prices could simplify comparisons. Yet, unlike buying cars or computers, most medical services remain challenging to shop for, often due to emergencies or their complicated nature.
According to researchers from the non-profit Health Care Cost Institute, merely 7% of the health expenses for people with employer-sponsored insurance involve services that can be straightforwardly purchased.
Fumiko Kayano, an oncologist at MD Anderson Cancer Center, stressed that expecting patients with severe illnesses to compare costs for complicated treatments isn’t realistic, especially when they require prompt action.
The burden of debt
Kayano emphasized that patients with high-deductible insurance often face large bills, leading to debt and a host of subsequent issues.
Recent research discussed at a significant oncology conference illustrated that cancer patients with high-deductible plans tend to have a higher mortality risk compared to those without such insurance.
Monroe’s family ultimately had to downsize, moving into a smaller apartment, while diminishing her savings, damaging her credit score, and losing her car.
“While other families enjoy holiday traditions, we simply can’t,” Monroe remarked.
Although she’s thankful for her children’s health and continues to work, Monroe is at a loss as to why anyone would advocate for a health model involving such high deductibles.
“We owe it to ourselves to approach healthcare differently,” she concluded. “People shouldn’t be treated this way.”
