How Do Consumer-Directed Health Plans Affect Vulnerable Populations?

Over the next decade, health care reform aims to expand access to health insurance coverage for low-income people and people with serious health problems. Employees with low incomes, however, may face cost challenges when put in high-deductible consumer-directed health plans (CDHPs) designed to reduce health care spending. They also may participate in health reimbursement accounts or health savings accounts (HSAs) that pay for qualified medical expenses. Do these benefit designs adversely affect vulnerable populations such as those who are chronically ill and people with low incomes?

These researchers examined medical claims information from 59 large U.S. employers, a majority of which offered high-deductible plans. They studied families enrolled in a traditional health plan the first year and then a high-deductible plan (with various levels of CDHP accounts) the second year and compared them with families enrolled in a traditional plan both years. Low-income families were identified by zip code. Chronic illnesses included the five conditions that account for 20 percent of health care spending.

Total spending was reduced 13 percent for both vulnerable and non-vulnerable families in high-deductible plans and even more (30%) for families with HSAs. Enrollment in CDHPs leads to reductions in care with greater consequences for lower-income and chronically-ill people than for others.