If you think you've never spent so much for health insurance since ObamaCare made health care "affordable," you're right. Health insurance premiums are going up quickly, and insurers have taken a number of steps, both visible and less so, to try to mitigate steep premium increases. But that often means patients are paying more out of their own pockets — a lot more.
One of the insurers' more visible attempts to lower premiums is to offer policies with very high deductibles.
Healthpocket, a technology company that compares health plans, reports that the average 2016 deductible for a Silver plan, the most popular in ObamaCare health insurance exchanges, is $3,117 for an individual, and $6,480 for a family.
For the Bronze plan, which is popular with people who do not get any government subsidy, the average deductible is $5,731 for an individual, and $11,601 for a family.
Democrats used to complain that high-deductible plans allowed "greedy insurers" to take premiums while avoiding paying claims. Indeed, high-deductible policies were what President Obama had in mind when he railed against "junk insurance."
Now extremely high deductibles are the hallmark of the Democrats' health care law.
But there are more subtle ways insurers are shifting costs to patients that most people may not recognize — until they get the bill.
Health insurers have long used tiered pricing for generic vs. brand-name drugs as a way to encourage more generic use. Then they added a third tier to separate their "preferred" — which some would argue means less expensive — brand name drugs from some of the newer drugs.
In 2009 insurers added a fourth (and in some cases a fifth) tier for certain high-cost specialty drugs, but with an important change — patients now often pay a percentage of a top-tier drug's cost rather than a set copay of, say, $10, $25 or $50.
For example, in one Blue Cross plan patients must pay 33% of the cost for specialty drugs in its top tier. Others require patients to pay as much as 60%.
Those out-of-pocket costs can hit even patients with good health coverage very hard. NBC tells the story of Lauren Baumann, who has leukemia and is insured, but must spend as much as $2,000 a month out of pocket to get the miracle drug Gleevec.
However, most of the discussion in these stories focuses on the cost of drugs, not the insurers' efforts to shift new costs to patients. There are two major problems with this approach.
First, there are often no alternatives for the newest drugs — at least for a while. Leukemia patients couldn't have chosen an alternative to Gleevec when it first appeared because there weren't any. So a lower-priced generic wasn't an option, though that will change soon.
Second, imposing these higher costs may be a subtle way of encouraging patients to shift to another health insurer — or to put it another way, of discriminating against patients with certain diseases.
For example, earlier this year the Chicago Tribune reported that two health insurers were charging significantly higher copays for drugs treating HIV and AIDS patients. According to the Tribune, based on an analysis of the Chicago market by the AIDS Foundation, "Several standard treatments cost more than $1,000 per month on many Coventry Health Care and Humana plans, while some of the same drugs cost as little as $35 on plans other insurers sell on the exchange."
The Affordable Care Act prohibits health insurers from charging a person with a medical condition more, but there are other ways insurers can make their plans less attractive to high-cost patients, and tiered prescription drug pricing is one of them.
In a free market, there would be no government mandate that insurers — any type of insurer — accept anyone who applies, and insurers would be free to charge a premium based on the risk a person brings to the pool. But ObamaCare largely eliminated medical underwriting, and the health insurance industry embraced that change.
Health insurers are understandably looking for ways to keep premiums as low as possible in light of the upward pressure ObamaCare is putting on premiums. But forcing patients to pay thousands of dollars a month for the drugs they need isn't the way to do it.
Regardless of what we do with ObamaCare, we need a new strategy for paying for expensive drugs, one that encourages innovation and competition, and yet ensures the public has access to those products. ObamaCare has only incentivized health insurers to pass more of the costs on to patients and taxpayers.