U.S. women enrolled in high-deductible health insurance plans are at risk of dying younger
If you are in a high-deductible health plan – especially if you are a woman – I encourage you not to get sick. And by all means, do not get breast cancer.
This is especially important advice for middle-class women in private health insurance plans. If you are poor enough to qualify for Medicaid, you likely won’t have to worry because few states impose out-of-pocket requirements for people enrolled in this publicly financed program for low-income individuals and families. For those that do, the deductibles and copayments are relatively nominal.
Women enrolled in Medicare will also soon get substantial relief from high out-of-pocket expenses. The Inflation Reduction Act, which was signed into law last year, will cap out-of-pocket medication expenses at $2,000 a year beginning in 2025 for Americans enrolled in the Medicare Part D prescription drug program.
And if you’re rich, you likely have enough money in the bank to pay for all the expenses your insurer refuses to cover.
Unfortunately, most women in the United States are not all that rich, nor are they eligible for either Medicare or Medicaid. And if they are enrolled in a high-deductible plan, they are at risk of dying younger because they don’t have the cash to pay for the care their insurers won’t cover.
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A new study published last week in JAMA Network Open found that breast cancer patients enrolled in high-deductible plans were less likely than women in PPOs and other traditional health plans to adhere to treatment. In the words of the researchers, “high out-of-pocket (OOP) costs are associated with treatment nonadherence and discontinuation.” (The study was funded by the American Cancer Society, but the researchers said ACS had no role in the design and conduct of the study).
In reporting on the research, Victoria Bailey of HealthPayer Intelligence noted that oral anticancer prescription drugs are crucial to breast cancer treatment but that “high out-of-pocket costs may prevent people from accessing medication.”
The researchers, based at Boston University, the University of Toronto, and the Princess Margaret Cancer Centre in Toronto, suggested that insurers and employers that offer coverage to their workers should follow the federal government’s lead for Medicare patients and voluntarily reduce out-of-pocket requirements for cancer patients with private insurance. They wrote that:
Recently passed federal policies seeking to reduce prescription drug prices among Medicare-insured patients could be complemented by voluntary employer or insurer efforts and state legislation to reduce [out-of-pocket] costs for commercially insured patients with cancers across care modalities.
Bailey pointed out that the researchers' findings were “supported by past research, which found that patients with new cancer diagnoses enrolled in high-deductible health plans experienced higher out-of-pocket costs than those with traditional insurance plans.” She wrote that:
Patients with colorectal cancer in a high deductible health plan paid up to $865 more per month in out-of-pocket costs. Patients with breast cancer paid $860 more per month, patients with lung cancer paid $655 more per month, and patients with other types of cancer paid $292 more per month than those in traditional plans, researchers found.
She went on to cite research that found that adults with high-deductible health plans were among those most likely to face difficulties navigating their health insurance benefits.
The study published last week is just the latest to show that high-deductible health plans can be hazardous to women – especially women of color. Researchers at the Boston University School of Public Health found in 2020 that Black women enrolled in high-deductible plans who have been diagnosed with breast cancer are far less likely to be diagnosed and treated than white women or other Black women enrolled in plans with modest or no out-of-pocket requirements.
They reported that “22.8 percent of Black versus 8.0 percent of white cancer survivors on high deductible plans skipped medication to save money. But among cancer survivors on other kinds of plans, 7.7 percent of Black versus 5.4 percent of white patients skipped medication.”
Megan B. Cole, the lead author of that study, wrote that:
As enrollment in high deductible health plans continues to rise, this has really concerning implications for racial equity among cancer survivors… Enrollment in HDHPs may compound the many structural inequities that Black cancer survivors are already facing, which may further drive disparities in health outcomes for survivors. Policies that limit deductible sizes and extend cost-sharing subsidies to high-risk groups, while limiting the types of services to which a deductible applies, may help to mitigate observed effects.
Both of these studies should be of interest to the Congressional Caucus for Women’s Issues and the Congressional Black Caucus – and all members of Congress who have a concern for the health and well-being of their female constituents, not to mention the women in their own families.