It’s annoying how the liberal message machine is cranking up to make a big issue of “underinsurance” — due to high deductibles — without ever admitting that Obamacare may have made the problem worse, as Byron York notes.
(To be sure: Yes, deductibles were rising before Obamacare. York seems to be a arguing that Obamacare made them rise faster — and indeed there appears to be a big jump after 2010. They’ve kept jumping since. You can easily see how Obamacare might have misguidedly accelerated the trend: 1) In addition to requiring insurers to ignore “pre-existing conditions,” it larded up “essential benefits” — so insurers had to try to claw the money back elsewhere ( i.e. deductibles); 2) It pushed people into shopping on the exchanges, where insurers tend to compete on the basis of monthly premiums, even if those premiums don’t buy that much insurance; 3) it tossed unsubsidized solo purchasers making as little as $47,000 into exchanges with the previously uninsured. When the exchanges turned out to be filled with lots of costly, sick and risk-taking people, insurers tried to keep premiums down by raising deductibles even more. If these unluckly exchange purchasers were in a more representative, society-wide pool they would not have to pay so much, either in premiums or deductibles.***
It’s also true that high deductibles are a traditional conservative remedy for rising health care costs. They may actually be working, in that respect. But they also can discourage even insured people from getting care or drugs that they need, for fear that they will wind up bearing the full expense. This happened to me recently — I went to an emergency room but walked back out when the intake nurse wouldn’t give me an estimate of cost — and I have a large, unnecessary scar on my leg to prove it.****)
** — If I remember right, there was a pithy bumper sticker in the 1996 campaign needling Clinton for his promise to fix the (marginal) excesses of that year’s big welfare reform bill, which he had signed: “ONLY CLINTON CAN UNDO WHAT HE HAS DONE!” In the event, the fixes were made. And Clinton at least acknowledged the flaws.
***–Families USA, a liberal lobbying group, seems to suggest (without actually blaming Obamacare, of course) that Obamacare regulations directly require higher deductibles or co-payments for some benchmark plans on the exchanges: “Due to federal requirements that govern the way silver plans are designed, these plans must have higher cost-sharing for more extensive or complex medical care” (page. 19). I don’t know what “federal requirements” they are referring to.
**** — Will display on request.