N Engl J Med. 2013 Oct 2. [Epub ahead of print]

The ACA and High-Deductible Insurance - Strategies for Sharpening a Blunt Instrument.

Wharam JF, Ross-Degnan D, Rosenthal MB.

Source

From the Department of Population Medicine, Harvard Medical School (J.F.W., D.R.-D.), the Harvard Pilgrim Health Care Institute (J.F.W., D.R.-D.), and the Department of Health Policy and Management, Harvard School of Public Health (M.B.R.) - all in Boston.

Abstract

The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care providers, and employers. High-deductible health plans (HDHPs), often considered "blunt instruments" that indiscriminately reduce utilization of both appropriate and discretionary care, require annual out-of-pocket payments of $1,000 to $10,000 for many services before more comprehensive coverage begins.¹ Unfortunately, large gaps remain in our understanding of HDHPs' effects on vulnerable populations, life-saving services, and health outcomes.²,³ In the ACA, Congress chose market-based cost controls over measures that are common internationally, such . . .