A tip of the topper to two reporters who took a good look at high-deductible health plans—the kind that can leave patients digging into their bank accounts to pay their medical bills while discouraging them from seeking care. Rachel Zimmerman at WBUR in Boston told the tale of a forty-year old man’s encounter with a high-deductible policy, and Mike Dennison, the state house reporter for Lee Newspapers, revealed Montana legislation aimed at making consumers pay more for their care.
Zimmerman found a young man named Matt S. who works in the health care industry and took a family policy with a $2,800 deductible, which applies to almost all treatments and procedures except for primary care and prevention. He was healthy—a marathon runner and a “minimalist” when it comes to taking medicines. He was also trying to be a good consumer—the kind marketplace devotees want to investigate the price of procedures, shop around for the cheapest ones, and make the decisions based on price and evidence.
To do that, Matt relied on a cost calculator supplied by his insurance carrier—unnamed in the WBUR report. Matt apparently has borderline hypertension, and his doctor, a physician in a practice owned by Brigham & Women’s Hospital, thought he needed a stress test to determine the severity of his condition. He turned to the calculator, which told him that a stress test would cost between $28 and $151. Doable, right? “I knew it was low,” Matt said. “You can’t even walk through the doors of the Brigham for $28.”
Turns out he also needed two echocardiograms, one before and one after the test. When it was all over, Matt had a bill for about $4000, including charges for the hospital and the cardiology group, and a diagnosis that meant he had to take medication. “The problem is, you don’t know that there are other components related to a cardiac stress test until you show up and have it done,” he told Zimmerman. “There’s really no easy way for consumers to find out all the pieces that might be included, either from the primary care doctor, the hospital, or the plan.” Bingo! Making consumers vote with their feet in the marketplace is easier said than done, Matt found.
He checked the calculator again for the price of echocardiograms—ultrasound studies of the heart—and found a price range of $147 to $290. He started to squawk, making calls to his human resource director, who called the insurance company representative who sold his employer the health plan. Matt was able to negotiate a lower bill, and eventually got the powers that be to lower his tab to $300. But the final bill was $0. Matt has soured on high-deductible plans. “I’ve had to fight or inquire about every claim. If I had to do it again, I would go back to the high premium plan and get rid of the high deductible.” A spokesman for the unnamed insurer admitted the cost calculator “is not s precise as we’d like.” A new one is coming in the fall—a good item for the tickler file.
Out in Montana, Mike Dennison tells us about the efforts of state Republicans to push plans that encourage Montanans to buy high-deductible insurance. Through a package of tax credits and deductions, state legislators want to entice individuals and businesses to buy these plans. Dennison’s story in the Billings Gazette is a state politics story on a topic not often tackled by statehouse reporters. It gives his readers a window on what state legislators are trying to do. What makes Dennison’s story so interesting is all those quotes he captured from proponents of these plans.
Readers learn that Rep. Cary Smith, a Republican who has sponsored several health care bills in the state legislature, believes that a high deductible plan “puts people in charge of their own health care. They have to go out and shop for their health care, so that drives down costs.” Cary apparently believes that if people choose not to have insurance and incurs a huge medical bill, they should suffer the consequences. “I’d have them paying it off for the rest of their life. Why should somebody get a benefit for being irresponsible?” Health insurance should be more like auto insurance, Smith argued. It should cover big accidents, rather than routine maintenance. It seems to me, and probably most folks in Montana, that their auto policy covers fender-benders, too.
Rep. Gary MacLaren, also a Republican, gave his take: “The idea is to get people at least partially responsible for health care. When people can save money if they don’t go to the doctor…they tend to take better care of themselves.” The RAND study points to a different conclusion.
All in all, Dennison delivered a good statehouse story, the kind that is much too rare. With the release of the RAND results, Dennison now has follow-up questions for Smith, MacLaren, and other legislators eager to get more Montanans into high-deductible plans. Dennison and other journos who want to write this story now have numbers that show the dark side of high-deductible health insurance.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.