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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 4 8 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A Y 2 0 1 5