Proponents of health savings accounts and their mandatory high-deductible health insurance plans have come out swinging against a study concluding that the plans cost women about $1,000 more per year than men.
NEW YORK — Proponents of health savings accounts and their mandatory high-deductible health insurance plans have come out swinging against a study concluding that the plans cost women about $1,000 more per year than men.
Advisers recognize that women often have greater out-of-pocket expenses than men under high-deductible plans, but that is not stopping them from recommending the plans and HSAs to both sexes when appropriate.
“I don’t differentiate between women and men in offering HSAs and high-deductible plans — they could be great for both,” said Lee Derrick, a principal with Derrick Financial Group in Annapolis, Md. He informs clients about the “worst-case scenario” of what they may have to pay under the plans and lets them decide if the plans are right for them.
High-deductible insurance is “discriminatory” and “punishes women for having breasts and uteruses,” said Dr. Steffie Woolhandler, a physician and lead author of the study, which analyzes medical costs of 33,000 U.S. adults. It was released this month by Cambridge (Mass.) Health Alliance, an affiliated hospital of Boston-based Harvard Medical School, where she is an associate professor. “It’s the same as giving all women a $1,000 pay cut,” Dr. Woolhandler added.
The additional costs are due mainly to women’s needing more regular checkups, specialized procedures and reproductive-
contraceptive services than men, the study found. They not only have to pay the deductible but often have to dip into savings — including HSAs — the study authors noted.
High-deductible health insurance is a prerequisite to eligibility for an HSA and is championed by many in the health-care field as a solution to rising medical and
premium costs. Deductibles usually are $1,000 to $5,000 a year, depending on the plan and whether the coverage is individual or family.
Under the rock
“When you lift a rock, you will find some worms,” said Teresa O’Keefe, vice president of marketing for ConnectYourCare, a Hunt Valley, Md., firm that administers consumer-directed health-care plans. “A previously opaque industry [health care] is being made transparent,” she said. But concluding from some evidence of additional costs that the plans discriminate against women is unfounded, Ms. O’Keefe noted.
“The author of the report has an agenda,” said Lori Gluth, senior vice president of Devenir LLC, a Minneapolis firm that creates HSA investment platforms. “[The author] is part of a group of physicians that is leading the charge for a single-payer national health-care system.”
Dr. Woolhandler responded: “A lot is implied in the word ‘agenda’ — it’s insulting. I do believe we need nation- al health insurance, based on my ob-servations of the health-care system, but this was a scientific study, and there were no conflicts of interest.”
“I am also an advocate of a national health-care system, because as a physician, I can see that the current system doesn’t work,” said the study’s co-author, Dr. David Himmelstein, chief of the division of social and community medicine at Cambridge Health Alliance and an associate professor at Harvard Medical School. “High-deductible plans have made things worse for my patients — not better,” he added.
The study’s findings seem “twisted,” because most high-deductible plans don’t count preventive care such as OB-GYN exams, mammograms and Pap smears against the deductible, said Vik Kashyap, San Francisco-based chairman of Canopy Financial, an HSA management firm in Chicago. The study’s statistics also are skewed, because it appears to be comparing high-deductible plans with socialized medicine, he added.
Statistics in the study are based on “the managed care of yesteryear,” Ms. O’Keefe said. “Costs are becoming commoditized. My yearly trip to the gynecologist costs $60 — not hundreds of dollars. Well-woman screening is about a $15 co-pay.”
But the study authors said that much preventive care still has to be paid by the patients.
“It’s true that some high-deductible plans will waive the deductible for some services, but we looked at the most common plan designs, and most of the time, nothing is waived,” Dr. Woolhandler said.
Plans vary in how they handle preventive care, noted Mr. Derrick, the Maryland adviser. Some waive the deductible, some have a small co-payment, and some make the client pay the full bill, he added.
Even if the deductible does not apply to preventive care, abnormalities revealed during preventive services — and their resulting costs — lead to patients’ spending their own money, Dr. Himmelstein said. They often have to exhaust not only their deductible but their HSA and other savings, as well, he added.
Whatever extra costs there may be are more than made up for by the premium savings of going to a higher deductible, said Paul Fronstin, senior research associate for the Employee Benefit Research Institute in Washington. “It appears that premium savings were not factored into the study’s calculations,” he said.
Premium savings were not factored in, because they apply to
men and women equally, said Dr. Himmelstein.
It is not fair to “condemn, stereotype and indict” high-deductible plans for something that can be handled through plan design, such as by increasing preventive-care benefits,” said Jerry Ripperger, director of consumer health group medical product management for The Principal Financial Group Inc. in Des Moines, Iowa. “These plans are still in their infancy — the hurdles will be overcome,” he said.
