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Sick Californians may be forgoing care because health deductible is too high, study says

October 28, 2010 | 12:04 pm

Three million Californians are enrolled in high-deductible health insurance plans because they can’t afford to pay high premiums.

But the often excessive out-of-pocket costs could be causing some to delay seeking care, while jeopardizing the financial well-being of others, a new report from the UCLA Center for Health Policy Research has found.

The report profiles California’s nearly 32 million insured residents and is based on data from the  California Health Interview Survey, conducted from 2003 to 2007, the largest statewide health survey conducted in the United States, according to the university health policy research center.

According to the report, high-deductible health plans are particularly prevalent among members of preferred-provider organizations, or PPOs, where 28% of participants reported being responsible for out-of-pocket expenses of more than $1,000. But costs can run as high as $2,000 or more for families and can exceed $5,000, the report found. Meanwhile, 14% of members of health maintenance organization plans, or HMOs, are enrolled in high-deductible plans, the report shows.

Low-income residents were more likely to have health plans with excessive out-of-pocket costs — as were 32% of low-income earners enrolled in PPOs, the report found. And some 38% of those individually insured, with no employer-based healthcare coverage, were also members of high-deductible healthcare plans.

Researchers also uncovered a connection between high out-of-pocket expenses and a reluctance to seek care. The majority of participants in high-deductible plans, for example 80% of Kaiser HMO members, reported that they did not have any savings account for medical expenses, according to the report.

The findings come as California establishes a new “health benefits exchange,” as part of recently enacted federal healthcare legislation. The exchange will provide insurance to the state’s uninsured, and under the law, out-of-pocket deductibles will be capped at $2,000 for individuals and $4,000 for families.

-- Ann M. Simmons