|Enrollment In Consumer-Driven Plans Remains Low, Survey Shows
Enrollment in consumer-driven and high-deductible health
plans (HDHPs) increased in 2007, but still makes up a small segment of
the overall insurance market, according to the third EBRI/Commonwealth
Fund Consumerism in Healthcare Survey.
Enrollment in consumer-driven plans with a
tax-advantaged account was 2 percent of the privately insured adults in
2007. One in 10 insured adults had HDHPs without accounts.
The survey also found the percentage of consumer-driven plan enrollees with high incomes (above $100,000) swelled in 2007.
Consumer-driven plans were introduced in 2001 with the
goal of decreasing the number of uninsured, encouraging
cost-consciousness among consumers, and increasing the amount of
information on the cost and quality of providers. The plans have been
controversial because of criticism they favor wealthy and healthy
participants at the expense of those with lower incomes and poorer
Results of the survey appear in the March EBRI Issue Brief and on The Commonwealth Fund Web site.
The EBRI/Commonwealth survey found differences in the
types of people enrolled in the various health plans. Consumer-driven
plan enrollees are in better health, are less likely to smoke, are more
likely to exercise, and to be white, male and higher-income.
They are no more likely to have been uninsured prior to
enrollment than adults in other plans. In terms of behavior, enrollees
in consumer-driven plans are more cost-conscious about their healthcare
than are people enrolled in more comprehensive plans, are less
satisfied with their plans overall, and are more likely to say they
avoided needed care because of cost.
Overall, the survey showed the following:
- Consumer-driven plans:
Enrollment in consumer-driven plans with a tax-advantaged account was 2
percent of the privately insured adult population in 2007, up from 1
percent the previous year. The 2 percent of the population represents
2.3 million adults ages 21-64 with private insurance.
- High-deductible plans:
Enrollment in high-deductible plans stood at 11 percent of the
privately insured adult population in 2007, up from 7 percent the
previous year. The 11 percent with high-deductible plans ($1,000 for
families, $2,000 for families) represents 12.5 million people ages
- Income levels: The percentage of
consumer-driven plan enrollees with household incomes above$100,000
increased to 31 percent in 2007, from 22 percent in 2005, according to
the survey. Just 19 percent of adults with consumer-driven plans were
in households with incomes of under $50,000 in 2007, down from 33
percent in 2005.
In addition, the survey found that 23 percent of high-deductible plan
enrollees were in higher-income households in 2007, up from 15 percent
in 2005. There was little change in the income levels of those enrolled
in more comprehensive plans.
- Satisfaction levels: As in 2005 and 2006,
individuals in consumer-driven plans and high-deductible plans continue
to be less satisfied with various aspects of their health plan than
individuals in more comprehensive plans. However, individuals in
consumer-driven plans were somewhat more satisfied with their plans in
2007 than they were in 2006, and there was a significant increase in
the share of consumer-driven plan enrollees who said they would
recommend their plan to a friend or co-worker and stay in their plan if
they had the opportunity to change.
"Although consumer-driven plans have been around since
2001, market penetration is small," said Paul Fronstin, lead author of
the EBRI Issue Brief. "Employers, especially large employers, appear to
be increasingly providing the plans as an option, but enrollment has
yet to take off."
"These findings show that over the three years of the
survey, more people in consumer-driven plans are earning higher
incomes, tend to be healthier and are no more likely to have been
uninsured prior to enrolling than people in traditional health plans,"
said co-author Sara Collins of the Commonwealth Fund. "These plans are
not yet solving the problems they set out to address."
The survey produced these additional findings:
Seven percent of consumer-driven enrollees were
uninsured before being covered by their current plan, compared with 15
percent among high-deductible enrollees and 28 percent among
individuals with comprehensive coverage.
Adults in consumer-driven plans are significantly more
likely to consider costs in deciding about healthcare than those in
more comprehensive plans, but the differences are not substantial.
There have not been significant gains in the amount of
information on provider cost and quality given to enrollees by health
plans of any type over the three years of the survey.
Among the 12.5 million individuals with a
high-deductible plan, 42 percent, or 5.2 million people, reported that
they were eligible for a tax-advantaged health savings account but did
not have such an account.
Individuals in consumer-driven and high-deductible plans
reported using health services at rates similar to those in
comprehensive plans, and there were no reported differences in the use
of preventive screens or tests. However, as in earlier years, the
survey finds that people in consumer-driven and high-deductible plans
are more likely to skimp on needed medical care or medications because
of cost than are those in more comprehensive plans. Over 2005-2007, the
reported rates of cost-related problems dropped among adults in
consumer-driven plans, though not among those in high-deductible plans.
The EBRI Issue Brief notes that because the cost of
health benefits has been increasing faster thaninflation and worker
earnings, employers have been seeking ways to manage the cost
increases. Recently, more workers have been subject to higher
deductibles and there has been growing interest among employers in
offering health plans with deductibles that are even higher than what
workers are used to seeing. Most of the activity in health plans that
combine high-deductibles with a tax-preferred savings or spending
accounts for healthcare expenses has taken place since 2004.
Addresses: Commonwealth Fund, 1 East 75th Street, New York, NY 10021; (212) 606-3800, www.cmwf.org. EBRI, 1100 13th St. NW, Suite 878, Washington DC 20005; (202) 659-0670, www.ebri.org.