Health insurance plans which have high deductibles can take a financial toll on Black patients, according to a new study of cancer survivors.The findings point to yet another reason for racial health disparities in the United States: High deductibles may make it harder for Black patients, in particular, to afford medications or see a doctor.Just because we have expanded health insurance coverage doesn’t mean people have access to the care they need, said lead researcher Megan Cole, an assistant professor at Boston University School of Public Health.
And for the Black patients, there are high deductibles may only compound the structural inequities that they already face.Deductibles are the set amount of money a person has to pay for health care before the insurance coverage kicks in. Plans with a bigger deductible generally have a lower monthly premium.And over the years, U.S. employers have grown fonder of them as the costs of health care steadily rise. Between 2009 and 2019, the percentage of employees in high-deductible plans rose from 8% to 30%, according to a Kaiser Family Foundation study.
Primarily till date, it has not been clear whether high deductibles could be adding to longstanding racial inequities in health care and health. To study the question, we have to take a look at national data on over 3,700 cancer survivors who were surveyed between 2013 and 2018.Overall, 44% were enrolled in a high-deductible plan. In that group, Black patients were more likely than white patients to have skipped medications, skipped doses, or put off filling a prescription in order to save money, the findings showed.There has been just over 28% delayed a prescription, for example, versus about 8% of their white counterparts.High deductibles were also a barrier to seeing a specialist, the study found: 15% of Black patients said they could not afford it, compared with 6% of white patients.Such wide racial gaps were generally not seen among cancer survivors on health plans with lower deductibles.
What constitutes a “high” deductible? It’s not just subjective. There are health plans that are formally defined (by the Internal Revenue Service) as high-deductible, explained Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, in Washington, D.C.For 2020, the IRS said a high deductible is at least $1,400 for individuals, and $2,800 for families.Alsohigh deductibles and other forms of “cost-sharing” may discourage people from opting for medical procedures that are “low value” — like an elective surgery with little evidence of benefits.
In recent years, Young said, some high-deductible plans have been designed to be “more nuanced.” They may, for example, cover necessary medications for chronic health conditions right away, and not apply the deductible.But ultimately, the root issue is the high price of health care.Based on the new findings, those price tags — and the cost-sharing that comes with them — may be disproportionately affecting Black patients.
The full extent of the harm is not clear. It has been said the data did not reveal the kinds of medications that cancer survivors skipped, or how it might have affected their health.But,the fact that they had to make that choice is concerning.Limits on the types of services that are subject to deductibles might help. But other measures are also needed, she added — from caps on deductible sizes to broader measures to tackle the “institutional racism” at the heart of health disparities.
Why are black patients getting different care?
Doctors take an oath to treat all patients equally, and yet not all patients are treated equally well. The answer to why is complicated.Cases like my patient’s above illustrate the negative assumptions and associations we can label racism, but most physicians are not explicitly racist and are committed to treating all patients equally. The sad truth is that,everything is being operated in an inherently racist system. And we also know that our own subconscious prejudices, also called implicit bias, can affect the way we treat patients.Basically, there are so many layers and levels to this issue, it’s hard to wrap our heads around it.
Nowadays we can clearly see that racism and discrimination are deeply ingrained in the social, political, and economic structures of our society. For minorities, these differences result in unequal access to quality education, healthy food, liveable wages, and affordable housing. Recently in the wake of multiple highly publicized events, the Black Lives Matter movement has gained momentum, and with it have come more strident calls to address this ingrained, or structural, racism, as well as implicit bias.
Deductibles are the set amount of money a person has to pay for health care before the insurance coverage kicks in. Plans with a bigger deductible generally have a lower monthly premium.In that group, Black patients were more likely than white patients to have skipped medications, skipped doses, or put off filling a prescription in order to save money, the findings showed.