High-deductible health plans hitting chronically ill, low-income members hardest, study finds

Nearly half — 46.9 percent — of low-income adults with multiple chronic illnesses and employer-sponsored high-deductible health plans face burdensome out-of-pocket healthcare costs, according to a JAMA Internal Medicine research letter published in October 2018.

For the research letter, authors from HHS' Agency for Healthcare Research and Quality examined Medical Expenditure Panel Survey Household Component data for adults age 19 to 64 with employer-sponsored health coverage. The data, which spanned 2011-15, included a main sample of adults with family income less than 250 percent of the federal poverty level, and considered 20 chronic conditions.

Researchers defined family out-of-pocket healthcare financial burden as the ratio of the total amount a family spent out-of-pocket on healthcare and premiums divided by the family's total disposable income. For the study, a 20 percent financial burden reflected high out-of-pocket costs, according to the authors.

Among all adults with high-deductible health plans during the study period, 7.3 percent saw a 20 percent burden. However, among low-income high-deductible plan holders with no chronic conditions or one chronic condition, the prevalence of high out-of-pocket costs grew to 20.6 percent. Bump that up to at least two chronic conditions, and 46.9 percent of low-income adults with a high-deductible plan faced burdensome out-of-pocket healthcare expenses.

"For clinicians and patients, high out-of-pocket costs for low-income adults with employer-sponsored insurance may create a barrier to achieving effective treatment to manage multiple chronic conditions," according to the authors. "Although only 22 percent of the overall low-income population had full-year employer-sponsored insurance, their financial burden is of concern."

For the full research letter, click here.

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