Study: High Deductible Health Plans Can Leave Workers in Debt

January 27, 2005 ( - Despite the recent move toward employers offering a high-deductible health plan tied to a health savings account, a new study suggested that the arrangement leaves workers with more debts than other programs.

A news release from The Commonwealth Fund, a health policy research group, said that about half of those with a high-deductible health plans are saddled with medical bill problems or debts compared to 31% of those in lower-deductible programs. The group said its survey also found that adults covered by high-deductible plans are also more likely to experience access problems such as not filling a prescription due to cost.

“Health savings accounts coupled with high deductible health plans have potential pitfalls, especially for families with low incomes or individuals with chronic health conditions, who are at greater risk of accruing burdensome medical debts and facing barriers to needed health care,” said Commonwealth Fund President Karen Davis, in the news release. “The evidence is that increased patient cost-sharing leads to underuse of appropriate care.”

Davis said that nearly two of five (38%) adults with high-deductible health plans report experiencing one or more of four cost-related access problems, compared with just over one-quarter (27%) of those with lower-deductible plans. The problems included:

  • not filling a prescription
  • skipping a specialist appointment
  • skipping medical treatment or follow up
  • not seeking medical treatment for new ailment.

Davis said the group is recommending legislative changes that it said could help prevent medical access problems and medical debt:

  • reduce deductible for lower-income families
  • exempt effective services and medications for patients with chronic conditions
  • require provider discounts for uninsured low-income families
  • cap income eligibility for tax-sheltered savings accounts – similar to Individual Retirement Account provisions
  • prohibit discrimination in favor of high-wage employees in funding health savings accounts by employers.

The Commonwealth Fund Biennial Health Insurance Survey was conducted from September 2003 through January 2004 by Princeton Survey Research Associates International. The survey covered 4,052 US adults aged 19 and older.