and former director of Medicare and Medicaid.
While $1,000 deductibles were once considered high, that's the norm
now as patients pay $1,500, $2,500 or even more than $6,000 before
their insurance kicks in. Add in co-pays and uncovered services, and
patients are paying more now than ever before for their health care.
"People are taking these plans because of the lower premium," says
Dr. Wilensky. "Whether they think it's as good of an idea when they
face a large healthcare cost is another thing."
An unintended consequence of these plans is that patients are think-
ing twice before undergoing elective surgery, to avoid paying their siz-
able deductibles. Critics point to low-income patients forced to skip
necessary medical care, and facilities facing higher debt and dwin-
dling volumes, as major problems with the plans.
"People get in over their head," says Corrie Massey, MBA, adminis-
trator of the Foothill Surgery Center at Sansum Clinic in Santa
Barbara, Calif. "They think they're saving money on the back end, but
it comes back to bite them."
An old idea becomes popular
Many argue the Great Recession expedited the process, as more
opted for plans with lower premiums and higher deductibles.
"With the recession, more employers were unable to afford to
absorb the high premiums, and instead shifted them to the employ-
ees," says Blayne Rush, MHP, MBA, president of Ambulatory
Alliances, a healthcare investment banking and M&A brokerage firm
that also advises physicians and ASCs. "As employees became more
responsible, they chose the higher deductibles over higher premiums."
The Affordable Care Act also played a part, says Mr. Rush. The
exchange's bronze and silver plans — featuring lower premiums and
higher out-of-pocket expenses — are currently the most popular
choices. Bronze deductibles tend to average around $5,000, according
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