The ACA and high deductible plans

Friend of the blog Michael Hiltzik published an email from David Goldhill, responding both to Michael and Galen. The latter two have argued that the ACA isn’t proven to be the cause of an increasing share of high deductible plans. I’m going to respond, because I think David’s comments are worth engaging, and because I think he’s falling into a common fallacy in thinking about TIE.

Let’s start here:

Reasonable people can disagree as to how meaningful our early knowledge of ACA’s effects is, but I don’t think they can argue — like TIE does — that there’s simply no evidence for the acceleration of this trend.

First of all, TIE is not an entity. We aren’t all one hive mind. And on this, I actually come down on David’s side a little (even though I don’t think Galen said that). I totally worry that the ACA is going to drive people into what I would consider high deductible plans. For instance, I wrote this at Bloomberg View (emphasis mine):

The revelation that many plans in the Patient Protection and Affordable Care Act’s health insurance exchanges have high deductibles has put many of the law’s conservative opponents into a corner: Once in favor of high deductibles, these critics of Obamacare are suddenly worried about the risk to consumers. The data show why their new position makes more sense.

Now unfortunately, Bloomberg edited out a section of that column for space reasons that now I can print here:

High deductible health plans, by the way, are defined as those with a minimum deductible of $1250 for an individual and $2500 for a family. The complaints of those who oppose the ACA are therefore somewhat odd, because many of the plans in the exchanges have deductibles far above those amounts. In fact, in Indiana (where I live), a cheap bronze plan for my family, costing just $342 a month, comes with a deductible of $12,700. Is that not high enough? How much higher would they like it to be?

Granted, that plan doesn’t include my physician. Private insurance companies often use networks of physicians to hold down costs. So a bronze family plan that has the most physician choice would cost us just over $1000 a month, with a deductible of $7000.

That’s still a high deductible. By any measure, such a plan would have qualified as such in the RAND HIE.

I totally think that the plans in the exchanges have high deductibles. I’m totally concerned about that, for all of the reasons that I’ve written about here on the blog many times before. I think that high cost sharing can lead people to avoid necessary care, and in people with chronic conditions, that can be worrisome.

So hear me: I’m concerned.

Now what I can’t predict is the future. I don’t know if my fears will play out, or if people will avoid the high deductible plans. But I totally acknowledge that the ACA could lead to a result I don’t like. It’s not a perfect law, as I — and others — have said many times here.

So I think this David isn’t right when he says this:

I must admit I find it surprising how closed many ACA supporters are to disagreement.

We aren’t. I don’t agree with everything that Austin thinks, or that Adrianna thinks, or even Galen thinks. But one of the great things about this blog is that we’re open to all of it, even the stuff we disagree with. It isn’t all pro-ACA all the time, nor is it all anti-something else. Austin can write glowingly about premium support (though also expresses concerns). I’m far less sold that it’d be good idea in any form.

We are far from closed to disagreement. It’s evidenced right here.


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