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High-deductible health plans are increasingly popular among healthy people, but a new study finds that these plans also enroll many low-income families with sick children.
The researchers, led by Alison Galbraith, MD, MPH, of the Children’s Hospital Primary Care Center, and Tracy Lieu, MD, MPH, of General Pediatrics, studied Massachusetts families signed up with Harvard Pilgrim Health Care. They identified 839 families that initially had traditional health maintenance organization plans, but were later switched to a high-deductible plan by their employers—as their sole option for coverage. About a third of these families had a child with a chronic condition, 13 percent lived in neighborhoods with high poverty, 36 percent had an above-average burden of illness and 19 percent had health-care costs totaling more than $7,000 per year.
Some clinicians and policymakers worry that high out-of-pocket costs may force families to forego recommended care. “The usual assumption is that high-deductible plans attract healthy and wealthy people, based on studies of those who chose those plans themselves,” says Galbraith. “Our population only had one plan offered to them, and we found that many families who were switched to high-deductible plans had children with chronic conditions. They didn’t have illness than families covered by traditional plans, but it was striking that they didn’t have less. As clinicians, we need to be aware of this as these plans become more popular.”
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