Health insurance deductibles pushed higher once again this year, according to a new report, contributing to a 10-year trend where out-of-pocket spending in employer health plans is causing financial anxiety for those with medical problems.
The California-based Kaiser Family Foundation on Wednesday issued its annual report on trends in employer-sponsored health insurance, which documented both the growth in deductibles plus an increase in the average premium for family coverage to nearly $20,000.
The average deductible for single coverage among all covered workers grew by more than 10 percent, the report found, while the growth rate in premiums was relatively low again this year at 3 percent for individuals and 5 percent for families. Since 2008, the general annual deductible for workers has increased eight times as fast as wages.
"It's sick people who use the most services who end up paying these costs," said Drew Altman, the Kaiser Family Foundation's president, during a news conference. "And so if you ask me ... where is the biggest problem in American health care today — or the biggest cost problem, certainly — it's the cost problems and worries of Americans who are sick."
Deductibles are sums of money that patients must pay out-of-pocket for health care services before full coverage generally kicks in. The Kaiser survey drew on responses from more than 4,000 employers with three or more workers.
The new report doesn't feature state-specific results, but the national trends have been playing out in Minnesota, said Elizabeth Lukanen, a health policy researcher at the University of Minnesota. Historically, Minnesota has had a relatively high share of workers enrolled in high-deductible health plans, Lukanen said.
"The deductibles are going up faster than premiums," said Lukanen, who studies the issue at the U's State Health Access Data Assistance Center. "We have long told a very similar national story, that the low premium increases over time have been offset by these much larger increases in deductibles."
Kaiser has been asking employers about health plan cost trends since 1999, when the total premium for family coverage — including contributions from employers and workers — was $5,791. That's less than one-third of the cost for family coverage this year, which the survey put at $19,616.
While the cumulative growth in inflation and worker wages has been 51 percent and 68 percent respectively since 1999, total family premiums have grown by 239 percent during the time period, the foundation says.
The new survey found that over the past decade, the share of workers in plans with a general annual deductible has gone from 59 percent to 85 percent. At the same time, the average deductible for individuals has more than doubled from $735 to $1573. This year, more than one quarter of covered workers have a deductible of at least $2,000 per year.
"More covered workers face a deductible, including a significant increase since last year," said Matthew Rae, a researcher at the Kaiser Family Foundation. "In addition to deductibles being more common, the cost of those deductibles is increasing."
With deductibles and premiums continuing to rise, employers surveyed by the foundation predict that a chunk of workers will opt to go without health insurance next year when the government drops Affordable Care Act penalties for people who don't buy coverage.
Nine percent of small employers and 24 percent of large firms say they expect fewer employees and dependents to participate in their health plans as a result of the change. In late 2017, President Donald Trump signed into law a tax bill that effectively eliminates next year an Affordable Care Act provision generally known as the "individual mandate."
The share of employers offering health benefits this year is holding steady at about 57 percent, according to the report. Employer plans are the single largest source of health insurance in the United States, the foundation said, with about 152 million people covered.
"We have a shortage of labor right now," said Gary Claxton, a vice president with the foundation. "Employers have to provide both enough wages to get them to work for them, but also benefits that are attractive or else people will go somewhere else."
Among large firms offering health benefits, 21 percent said they collected some information from workers' mobile apps or wearable devices such as FitBit as part of employee wellness programs, up from 14 percent last year.
About three-quarters of large firms that offer health benefits cover services provided through "telemedicine," meaning video chat and remote monitoring. The share is up from 63 percent last year and 27 percent in 2015, although a separate Kaiser study suggests very few workers are substituting these visits for trips to the doctor.
And the survey found that about three quarters of large firms offering coverage also are covering the cost of health care services provided at retail clinics.