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Segel JE, Kullgren JT. Effects of high-deductible health plan enrollment on out-of-pocket spending and high medical cost burdens among Americans with chronic conditions. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 26; Boston, MA.
Effects of high-deductible health plan enrollment on out-of-pocket spending and high medical cost burdens among Americans with chronic conditions Research Objective: As enrollment in high deductible health plans (HDHPs) continues to increase for both individuals with employer-sponsored insurance and those obtaining coverage through Federal and State Marketplaces, many are concerned about the effects of these high levels of cost-sharing, particularly among those with chronic conditions. However, little is known about how HDHP enrollment affects actual out-of-pocket (OOP) spending for Americans with chronic conditions. The objective of this study was to compare the association between plan deductibles and OOP spending and high medical cost burdens among privately-insured US adults with chronic conditions. Study Design: We used 2011-2013 Medical Expenditure Panel Survey data that includes information on whether a plan has a high deductible (using the respective IRS definition for each year), a low deductible, or no deductible. We used quantile regression to estimate the association of each plan type with overall OOP spending among adults with at least one common chronic condition (i.e., heart disease, hypertension, diabetes, asthma, joint conditions, cancer excluding skin cancer, and mood disorders), for each individual chronic condition, and by presence of multiple chronic conditions. Finally, we used logistic regression to estimate the probability of having high medical cost burdens, which we defined as spending at least 10% of family income on health care services and premiums. All models included controls for age, sex, race/ethnicity, education, marital status, income, employment status, and self-reported health status. Population Studied: Non-elderly US adults with private health insurance for at least 1 year. Principal Findings: Among chronically ill individuals, median spending was $250 higher for individuals with HDHP's (P < 0.001) and $120 higher for individuals with low deductible plans (P < 0.001) compared to median spending of $360 for individuals with plans with no deductible. We found significantly higher median OOP spending ($670,) compared to those with low ($520, P < 0.001) or no deductible ($360, P < 0.001) plans. These differences were greater at the upper end of the OOP spending distribution. For example, among individuals with any chronic conditions, at the 90thpercentile, spending was $ 980 higher for individuals with an HDHP (P < 0.001) and $380 higher for individuals with a low deductible plan (P < 0.001) compared to those with no deductible. We found the greatest disparities in OOP spending between individuals with an HDHP and those in a low or no deductible plan among adults with diabetes, heart disease, mood disorders, and multiple chronic conditions. In addition, among individuals with any chronic condition, we found those with an HDHP were more likely to spend at least 10% of family income on health care and premiums (odds ratio 1.90, P < 0.01). Conclusions: Non-elderly US adults with chronic conditions who are enrolled in HDHPs have significantly higher OOP spending and more likely to face medical care cost burdens than those in plans with low or no deductibles. Implications for Policy or Practice: As more Americans with chronic conditions enroll in HDHPs through both employer-sponsored insurance and Federal and State Marketplaces, policymakers should take steps to ensure the high cost-sharing these individuals face does not lead to adverse financial outcomes or impede receipt of high-value health services.