Navigating the Rise of High-Deductible Health Insurance

Childbirth is the most frequent reason for hospitalization in the U.S. and high-deductible health plans (HDHPs) will soon become the most common insurance arrangements for expectant mothers.  Although the Affordable Care Act (ACA) mandates that health insurers cover birth hospitalizations, it does not limit cost sharing except through relatively high annual out-of-pocket maximums.  Thus, childbirth-related cost sharing may increase significantly.

The potential implications of the increasing financial burden of childbirth could be considerable.  Women whose only insurance option is an HDHP might postpone having children until they have more savings or can enroll in a more generous insurance plan, a delay that could have adverse health effects for mothers and infants.

Another possibility is that women in employer-sponsored HDHPs might switch to a spouse’s more generous coverage or to public insurance, especially given that pregnancy can increase the likelihood of eligibility for Medicaid or subsidized health insurance exchange plans. If this happens, federal and state health care spending for childbirth could increase.

Moreover, switching health insurance plans near the time of delivery could create lapses in coverage if women experience administrative delays in obtaining their preferred health insurance, potentially impacting continuity of care.

According to lead author and DPM faculty member Frank Wharam, MD, MPH  and co-authors, several policy changes could improve expectant mothers’ use of HDHPs, including (1) personalized coverage, quality, and out-of-pocket cost information; (2) decision support tools; (3) incentives to encourage savings for childbirth costs; and (4) subsidies to assist financially vulnerable women.

Dr. Wharam and colleagues believe that such approaches could encourage value seeking and would be a sound investment in the health of families.