Employees Start to Feel the Squeeze of High-Deductible Health Plans

I like it too, except that my (bronze level in the marketplace) high deductible plan is ~$1300 a month for my family, that is not sustainable. A recent ER visit with 1 night stay cost us about 8k out of pocket, the family deductible for the plan is $13k a year.

I'd like to know if there's any empiric data on how many people go to the ER for something that "wasn't really an emergency."

Then I'd like to know how many people have died because they didn't go to the ER for something that really was an emergency.

My guess would be that the latter greatly outweighs the former. And I'd follow up that guess with a wager that a large percentage of those people failed to go to the ER because they were worried about the cost.

If that's the kind of decision that high-deductible health care encourages, I don't think it's worth it.

One of our company's primary products "helps employees make an informed decision when choosing their health insurance plan". Basically, during open enrollment they are presented with their choices of plans and the "expected total cost" of each plan over the course of the year as calculate based on either, if we have their consent, their historic data or, if we don't have their consent, the historic data of a representative cohort.

The product wasn't getting traction based on employer's wanting to provide such a service to their employees, so the sales pitch was changed. The sales pitch became, "You can save your company money by moving your employees to High Deductible Health Plans. Our product presents data that encourages employees to choose HDHPs over other plans." I'm not sure if that is currently the sales pitch, but it was the primary one for two-ish years. Our customer base is now non-trivial.

I've overheard some of the conversations as to how the "representative cohort" is determined and about our data sources. It wouldn't pass a peer review. Additionally, in the past we have re-worked the numbers because our customer didn't like the results. That is, feedback from the company, not the company's employees. They did, after all, hire us to get their employees to move to a HDHP.

And to top it off, the product hasn't been a great revenue source. So we're effectively compromising real people's health care coverage, for our company's business interests, and it hasn't even been that profitable.

Our health insurance plan at this company is a HDHP...

Except that early diagnosis has been shown consistently to improve outcomes and reduce costs.

> The only "advantage" is that companies have to pay smaller premiums and employees are greatly discouraged from getting care due to high costs.

In principle the advantage is that employees are greatly discouraged from paying too much for care. If the insurance pays for everything then what do you care if your doctor is charging $1000 for a physical instead of $50? If you're paying out of pocket, now you care.

The problem is we also have a lack of price transparency, so it's arduous to actually determine the price you'll be charged for routine care and avoid the places who are overcharging, which correspondingly becomes nearly everyone. The states would do everyone a favor to pass and enforce some price transparency laws.

And the advantage of lower premiums is that it allows you to receive that money. If your employer is raising your plan's deductible and giving the balance saved in premiums to you, that's the advantage -- you get the money. If they're not, go ask for a raise or find another employer who will pay you more, in the same way you would if they lowered your compensation in any other way.