Add rising deductibles on health insurance policies to a growing number of financial problems forcing some Nashville-area residents to delay needed medical care.
Coming at a time of job loss and higher unemployment in the state, the higher costs run the risk of creating sicker patients who put off care too long, critics say. The trend also is a double-edged sword that could mean less revenue for cash-strapped hospitals, doctors and other providers as the national economy slows down.
Consider Ron Brumley of Old Hickory. He's had a sinus infection for the past month, but he has not visited a doctor because under his employer's new health plan he'd have to pay the first $2,500 before insurance kicks in.
Or Bethpage resident Ress Benson, who says he has put treatment for a common form of skin cancer on hold because of the $5,000 deductible on the individual health plan that he signed up for after losing his job six months ago.
These Middle Tennessee consumers aren't alone in feeling the effects of rising deductibles. Last year, the median deductible required by employers for individual coverage in preferred provider organizations, or PPOs — the most popular type of health plan with 69 percent of all covered employees — rose to $1,000 from $500, according to the National Survey of Employer-Sponsored Health Plans conducted each year by Mercer consultants.
The number of employers that impose a deductible for PPO coverage also has risen from about half in 2000, when the median deductible for individual coverage was just $250, to about
80 percent today, according to Mercer.
Many deductibles reset at the start of the new year, and delays in patients' seeking care have some hospital executives on edge.
"A lot of it is going to depend on if consumer confidence goes up," said Craig Becker, president of the Tennessee Hospital Association. "One thing this taught us is that hospitals aren't immune to a lack of consumer confidence. If they won't buy a car, they won't take an elective surgery either. They don't want to pay the co-pay."
'I can't afford to be sick'In Brumley's case, his employer abandoned a PPO plan last fall in favor of a high-deductible health plan with a health savings account. By doing so, Five Oaks Golf and Country Club of Lebanon avoided a 27 percent jump in its monthly insurance premiums while shifting more responsibility for managing health costs to its employees.
Brumley now pays about $9 less a week in premiums on a plan that covers him and his wife, Judy. Each of them also must pay out of pocket the first $2,500 in expenses (including for drugs) before insurance benefits start.
Brumley said he has put off his own care, and the couple's first priority is to pay for his wife's visits to a pain clinic — plus some medications. His wife suffers from back pain and has diabetes.
"I can't afford to be sick," Brumley said.
Still, Judy has had to go without some prescribed medications, such as the anti-diabetic drug Metformin, and she hasn't yet filled a prescription for the cholesterol medicine Zetia. "It's terrible because my whole disability check is going on medicines, but I can't afford this. Sometimes, we have to cut back on groceries and things like that — and it's pitiful," she said.
Studies have shown that people in high-deductible health plans are more likely to cut back on care and prescriptions.
"It's like anything — when the price is higher, people cut back," said Jessica Greene, a professor of health policy at the University of Oregon. "The problem is people don't always know when they're cutting back on care that doesn't really matter versus care that has long-term health consequences."
Employers may sufferOften, the use of health-care services rises in recessions as consumers who feel less secure about their jobs rush to get treatment while they're still employed and insured.
But higher employee cost-sharing — such as higher deductibles — might prevent that spike this time around, said Jim Horrell, a principal in Mercer's Nashville office.
Christopher Parks, chief executive of change:healthcare consultants here, said employers that keep increasing deductibles might face higher costs in the long run if employees delay care and develop more serious health problems. He favors an approach that reduces barriers to preventive care.
For some consumers, high-deductible health plans aren't a matter of choice.
Benson, the Bethpage resident, who moved to Middle Tennessee from Los Angeles two years ago, said several insurers considered his skin cancer a pre-existing condition, and that made it difficult to get individual coverage on favorable terms. He ended up with insurance that costs $400 in monthly premiums and comes with a $5,000 deductible.
The former sales representative with a Lebanon homebuilder said he is praying to be healed of the skin cancer and hoping that he doesn't have to use his insurance policy for a major illness.
"If it's a catastrophic thing, I'll find a way to come up with the five grand for that care," Benson said. "If it's not major … you've got to put it off."
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