High-Deductible HPs Keeping Lower-Income Workers from Care

Research out Wednesday from the Integrated Benefits Institute finds that one-third of workers go without needed care because they can’t afford it, which can increase their sick days by almost 70%. The analysis comes as deductibles, copayments and coinsurance costs continue to rise as a growing number of employers put the onus on workers as they try to manage their healthcare spend.

“What a lot of employers are learning is that cost-sharing is a blunt instrument,” says Brian Gifford, IBI’s research director and the study’s lead author. “If they roll out cost-sharing strategies without knowing how it affects the affordability of care for employees, they’re gambling that there won’t be more serious issues driving higher-cost care and lost productivity down the road.”

Enrollees in a high-deductible health plan–$1,100 or higher for a single plan or $2,200 or higher for a family plan–were 75% more likely than low-deductible enrollees to experience a cost-related barrier to care, IBI found. Although health-savings accounts, which are rising in popularity, didn’t reduce the risk of cost-related barriers for employees with high deductibles, flexible-spending accounts and coverage for prescription medications were associated with reduced risk of experiencing cost-related barriers to care.

IBI’s analysis examined nationally representative data collected by the Centers for Disease Control and Prevention between 2007 and 2017 and focused on employees with annual family incomes below $35,000.

High-deductible plans continue to grow in popularity, yet that change comes as many workers say they are unable to pay a $400 emergency expense without selling something or borrowing money, a Federal Reserve report found.

Meanwhile, patients experienced out-of-pocket increases as high as 12% for their healthcare costs last year, according to a recent analysis by TransUnion Healthcare.

In addition to highlighting healthcare-cost problems, the IBI analysis provides more evidence of the value of a healthy workforce, Gifford says, while also underscoring the importance of a robust benefits package.

“When we see people not getting the care they need [and] taking more time off, it underscores that health benefits are an investment in how a business performs,” he says. “So, like any investment, employers need to understand which parts of their portfolio are doing better than others. Cost control is just one approach to getting better returns. Helping employees understand what is covered at low or no cost is another, but so is ensuring that all employee benefits–including time-off policies, disability and leave benefits, wellbeing programs and supportive services–complement an overall investment strategy.”

Previous research from IBI found that poor employee health costs U.S. employers $530 billion and 1.4 billion work days of absence and impaired performance a year.


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Kathryn Mayer
Kathryn Mayer is HRE’s former benefits editor and chair of the Health & Benefits Leadership Conference. She has covered benefits for the better part of a decade, and her stories have won multiple awards, including a Jesse H. Neal Award and honors from the American Society of Business Publication Editors and the National Federation of Press Women. She holds bachelor’s and master’s degrees from the University of Denver.