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Congress seeks to help patients overcome high deductibles


A new bill in Congress is designed to help overcome one of the most challenging barriers patients face when accessing care: the out-of-pocket cost.

A new bill in Congress is designed to help overcome one of the most challenging barriers patients face when accessing care: the out-of-pocket cost. But it’s unclear if it can get through Congress this year.

In July, Representatives Diane Black (R-Tennessee) and Earl Blumenauer (D-Oregon) introduced HR 5652, the Better Access to Care Act of 2016, to make some types of coverage more affordable for the growing numbers of Americans with high-deductible health plans (HDHPs) paired with health savings accounts (HSAs). 

The legislation would address the IRS rule that says HDHPs with HSAs can’t be used to cover services for patients with pre-existing conditions unless the patient has covered the single-visit or annual deductible. A patient with diabetes, for example, must pay for an annual eye exam out- of-pocket unless she has already paid her deductible in full.

This provision forces some patients with HDHPs and HSAs to forego such care, explains A. Mark Fendrick, MD, an internist and professor in the department of internal medicine at the University of Michigan in Ann Arbor.

“This bill is the most common sense healthcare reform idea that no one has heard about,” Fendrick says.  

In 2005, only 2% of employers offering health benefits had these kinds of plans. By 2015, it had risen to 20%. As of January 2015, 19.7 million Americans had an HDHP and HSA, an increase of 13.2% from a year earlier. The average deductible for individuals enrolled in these plans last year was $2,196 and for families it was $4,347, the Kaiser Family Foundation reported.


“Why would you make it harder for my patients to do the things that I beg my patients to do?” asks Fendrick, director of the university’s Center for Value-Based Insurance Design. He argues that high deductibles should be reserved for low-value services such as those identified by the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, and eliminated for high-value care such as the services and medications recommended in clinical care guidelines. 

Black has experience with patients who have HDHPs with HSAs and who struggle to pay for care. Before being elected to Congress in 2010 from Tennessee’s Sixth Congressional District, she worked as a nurse for 40 years.

“I saw this issue present itself over and over again, particularly in my work as a long-term care nurse,” she tells Medical Economics. “Typically it wasn’t an intentional decision at the outset not to take a prescribed medication, it was simply a matter of life happening and other costs getting in the way.” When forced to choose between buying groceries and filling a prescription, a patient will make healthcare a lower priority every time, she says.

Federal regulations already allow patients to get certain types of preventive care without paying a deductible first, Black says. “It only makes sense to create a separate exception for medications and services people depend on to manage a chronic condition,” she adds.

The IRS regulation not only makes it difficult for patients to afford the care they need, but could make it challenging for physicians to take full advantage of quality-driven payment models that base bonuses on the use of specified clinical services, Fendrick says.

Black is unsure if Congress will pass the bill before year end, but she remains hopeful.  


Joseph Burns is an journalist in Falmouth, Massachusetts. Do you think this bill would help your patients? Tell us at medec@ubm.com

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