The ACA and High-Deductible Insurance — Strategies for Sharpening a Blunt Instrument

By mandating insurance coverage and requiring affordable premiums but not enacting other cost-control mechanisms, the Affordable Care Act will cause a major shift toward high-deductible health plans — increasing the urgency of determining such plans' consequences. The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care pro-viders, and employers. High-deductible health plans (HDHPs), often considered “blunt instruments” that indiscriminately reduce utilization of both appropriate and discretionary care, require annual out-of-pocket payments of $1,000 to $10,000 for many services before more comprehensive coverage begins. 1 Unfortunately, large gaps remain in our understanding of HDHPs' effects on vulnerable populations, life-saving services, and health outcomes. 2 , 3 In the ACA, Congress chose market-based cost controls over measures that are common internationally, such . . .