AAP concerns about High-Deductible Health Plans

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1. The American Academy of Pediatrics (AAP) recommends that the government consider restricting high-deductible health plans (HDHPs) to individuals over 18 years of age. 

2. The AAP recommends that HDHP policies be redesigned to provide primary care visits and other beneficial procedures without deductible or co-pay. 

3. If children are to be offered HDHPs, the AAP recommends that allowances be made for “children with special needs” in the form of eliminated deductibles. 

Statement Rundown: In a policy statement released today, the AAP expressed concern about the impact of HDHPs offered through the Affordable Care Act on health seeking behavior of families.  HDHPs decrease the monthly premium costs of insurance policies by forcing the patient to confront the costs of additional, nonpreventative primary care in the form of higher deductibles. While there is evidence of cost-savings with this approach, such a model also facilitates adverse selection, in which healthy patients opt for lower premiums while the conventional plans are left with ill and higher cost patients, in turn increasing premiums.  Federal law mandates that HDHPs cover basic preventive services with no deductible or copay; however, data suggests that families with high deductibles at point of care will seek to minimize their out-of-pocket expenditures, which may result in foregoing medical care, particularly primary care services.

In this statement, the AAP strongly recommends that the federal government consider restricting HDHPs to individuals older than 18 years. The AAP supports the recommendation by the Bipartisan Policy Center for Medicare Patients – HDHP policies should permit a number of annual primary care visits that are exempt from deductibles. They additionally recommend that insurers take steps to emphasize the importance of preventative services to its policyholders and to ensure that policyholders understand that these services are not subject to deductible payments. The AAP also asks that policymakers continue to explore alternative strategies that may reduce healthcare costs without negatively affecting primary care such as the development of value-based insurance plans, and the reduction of high prices instead of utilization.

Click to read the policy statement, published today in Pediatrics

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