They were ill-prepared to deal with sharply escalating health-care bills: Carla’s gallstone, her diabetes diagnoses, John’s seizures, followed by a serious campylobacter infection. The family couldn’t afford the $1,000 it would cost for Carla’s six-week diabetes class. Instead, she got a 40-minute crash course. They shelled out $125 for five pills to treat John’s infection. Still, the bills were piling up. Early in 2017, Carla took a day off from work to go through the stacks of paper, calling each office to negotiate. Few were willing to help.
“It did not really matter to them,” she said. “It was just, ‘When can you pay and how much can you pay?’”
By last year, the couple was making about $79,000, before taxes. They have no savings for retirement or for their children to go to college. “We both live paycheck-to-paycheck,” Carla said. They pay about $35 a month for medications for John’s blood pressure and acid reflux. Carla takes inexpensive metformin—just $3 a month—for diabetes, and doesn’t yet need insulin.
But her diabetes test strips and lancets cost $120 for a three-month supply. To stretch them as long as she can, she checks her blood sugar only when she feels dizzy or nauseous, rather than the standard three times a day. When she had the flu this past winter, she put off going to the doctor until her fever hit 105.
The Jordans’ response to spiraling family medical costs is repeated in families across the country, studies suggest. When one large employer switched all its employees to high-deductible plans, medical spending dropped by 12 percent to 14 percent, according to an analysis by economists at University of California, Berkeley and Harvard. But the workers weren’t learning to shop more effectively for health care. They simply reduced the amount of medical care they used, including preventative care. In high-deductible plans, women are more likely to delay follow-up tests after mammograms, including imaging, biopsies and early-stage diagnoses that could detect tumors when they’re easiest to treat, according to research in the Journal of Clinical Oncology.
“High-deductible plans do reduce health-care costs, but they don't seem to be doing it in smart ways,” said Neeraj Sood, director of research at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.
Some big companies are sitting up and taking notice. “We all thought high deductibles are going to drive people to get involved—‘skin in the game,’” Jamie Dimon, the chief executive officer of JPMorgan, said in early June. Instead, “they didn't get the surgery they needed, when they needed it, because they can't afford the high deductible in one shot." JPMorgan is effectively eliminating deductibles for workers making less than $60,000 a year.
Dimon has teamed up with the top executives of Amazon.com Inc. and Berkshire Hathaway Inc. to improve the health care they provide for their workers. The incoming CEO of that venture, surgeon and journalist Atul Gawande, has also noticed the plight of such families as the Jordans. “I had one friend who was bankrupted with a health plan,” Gawande said at the Spotlight Health event in Aspen, Colorado, on Saturday. “He had a $3,000 deductible and couldn’t meet it.”
About five years ago, CVS switched all of its 200,000 employees and their families to health-insurance plans with high deductibles. As the company pushed more costs onto employees, some stopped taking their medications.
“Nobody in their right mind would think that it's a smart thing to basically be keeping people away from taking their medications,'' said Troy Brennan, the chief medical officer at CVS. The company had initially offered a limited selection of generic drugs for free to its workers. But evidence that people were skipping medications prompted CVS to broaden the list, including some brand-name treatments and insulins on the free-drug list, an approach it now recommends to its corporate customers.