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The devastating ripple effects of high-deductible health insurance

The devastating ripple effects of high-deductible health insurance
Tomas Krusliak of Blackburg, Va., who has health insurance, faced thousands of dollars in medical bills after his wife suffered a miscarriage. (David Hungate / For The Times)

To the editor: As a mental health provider in a rural county, I have seen how high-deductible insurance plans prevent individuals from accessing needed mental health services.

Psychotherapy usually occurs weekly for the initial eight weeks at least; however, if you have a $30 or $40 co-pay or a high deductible that you have to meet, you might instead choose to forego a much-needed treatment. These plans may end up costing more for everyone when these patients visit the emergency room or their primary care physician more frequently due to health problems that can be the result of untreated depression, anxiety or trauma.

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Even if individuals bite the bullet and start searching for psychotherapy, it can be a battle to find a provider. Insurers take months to credential and contract therapists.

Amanda Pyper, Solvang, Calif.

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To the editor: High-deductible plans were designed to supplement well-funded HSAs, or health savings accounts. Health economists knew they would not work without adequate funding in the HSA.

The problems of higher deductibles and great medical debt are directly caused by cost shifting, first by the government and then by corporate America, that puts a heavier burden on those who purchase small group or individual policies.

Medicaid only pays a portion of the charges that hospitals and other providers request. In a county like Los Angeles, where nearly 50% of patients have Medi-Cal, there is a dramatic cost shift that eventually gets passed on to the consumer. This is a hidden tax that hits the middle class the hardest.

The Affordable Care Act made the situation worse, as those who purchase very subsidized plans on the insurance exchanges are mostly insulated since since the federal government picks up a portion on their costs. So they could sell affordable policies, insurers narrowed networks and dramatically increased deductibles without having an HSA to cover those expenses.

Not until Sacramento and other state legislatures pay at Medicare rates will the situation ever change.

Howard C. Mandel, M.D., Los Angeles

The writer is vice president of the Los Angeles Health Commission.

Follow the Opinion section on Twitter @latimesopinion and Facebook

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