Rush is on to get health care under old insurance plans

44% of companies in one survey were considering offering workers only a high-deductible health plan.

When Cynthia Edson learned how much her husband's employer-provided health insurance plan would change in 2014, she compiled a to-do list:

* Get a skin-cancer check and an appointment with a gynecologist.* Renew and fill the family's prescriptions.* Schedule a blood draw for her husband and youngest daughter.

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Edson sprang to action because her husband's employer drastically changed its health-insurance plan for 2014.

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Citing the nation's new health-care law, the company switched to a high-deductible plan that won't pay for medical care until the family spends $4,000 out of pocket.So, like many others, Edson is cramming in all of the health care she can to take advantage of her more generous plan that ends Dec. 31.

'We're trying to get everything we can get done right now,' said Edson of Chandler, Ariz. 'We're not the only ones feeling this pressure. We're competing with everyone else who is doing the same thing.'

Doctors, insurers and health-care analysts say the rush to use medical benefits before the year ends is a real phenomenon.

Consumers try to get all of the health care they need before newer, less-generous plans start. Or they schedule non-emergency 'elective' procedures toward the end of the year, after they have met deductibles that require them to spend $1,000 or more before coverage kicks in.

Such high-deductible plans are a popular choice for employers seeking to share costs with employees.

About 2 of 5 workers who received health insurance through an employer had a deductible of at least $1,000 this year, according to an annual Kaiser Family Foundation and Health Research & Educational Trust survey of more than 2,000 large and small employers.

National surveys suggest that corporations have been shifting health-care costs to employees for years by raising premiums, co-payments or deductibles. The Kaiser poll found that the cost of the typical plan rose 80% in the past decade, but the worker's contribution increased 89% in that same time period.

Still, employers paid an average of $11,786 per family plan in 2013 while a worker's share was $4,565.

Professor Daniel Derksen of the University of Arizona's College of Public Health said such costs become a competitive issue for businesses, and some companies may see the health-care-reform law as a strategy to offset rising costs for health insurance.

'It's always nice to have a villain to blame,' Derksen said. 'These days, it's easy to blame Obamacare.'

^'It's always nice to have a villain to blame. These days, it's easy to blame Obamacare, ^'

- Daniel Derksen, University of Arizona

Proponents of the Affordable Care Act insist that the law should not trigger major changes to employer-provided health insurance, but some companies have cited the law as a catalyst for converting to high-deductible plans, charging more for coverage or dropping coverage for part-time workers.

United Parcel Service cited the law as one reason it is eliminating health insurance for about 15,000 spouses who have coverage options elsewhere. Retailers Home Depot and Trader Joe's both dropped coverage for part-time workers, sending those employees to government-run marketplaces.

The health-care law requires companies with 50 or more employees to provide affordable health insurance or pay a penalty.

The mandate is for employees who work at least 30 hours a week, and it does not take effect until Jan. 1, 2015.

But next year, employers must pay a 'reinsurance' fee that will be used to stabilize rates in the new online marketplaces, and many employers are citing that fee as a factor for charging more, covering less or a combination of both. A national survey by Aon Hewitt consultants suggests that the Affordable Care Act's taxes and fees add 1% to 2% in direct costs to employers.

The Aon Hewitt survey found that 44% of companies are considering offering workers just one health-insurance plan - a high-deductible plan - rather than offer a high-deductible plan plus a more traditional plan that covers 70% to 80% of medical costs.

Gannett Co. Inc., which owns USA TODAY and The Arizona Republic, is among the companies offering only a high-deductible insurance plan in 2014.

Family plans covering less

Health-insurance executives describe high- deductible plans as 'consumer-driven' because they make employees responsible for a larger share of their health-care costs. These plans often are coupled with health savings accounts, which allow employees to put away pretax money that can be spent later on medical care.

Such plans theoretically encourage consumers to make smarter choices and skip care that isn't necessary.

'That is what a consumer plan is designed to do. It pushes more accountability to employees,' said Denise Jewell, a principal with Mercer benefits-consulting firm.

Other experts say that while the Affordable Care Act's direct expenses are limited, the law gives companies an excuse to scrutinize how much they are spending and make changes.

'Small and large businesses are going to look at this as an opportunity to really think about health-insurance benefits they are offering to employees,' said Derksen, the University of Arizona professor. 'Business decisions will be made about what is the best value.'

Edson's family gets coverage through her husband's employer, Atlanta-based HD Supply. The Edson family now has a plan that covers 70% of medical costs.

HD Supply, which employs about 15,000, is switching Jan. 1 to a high-deductible plan combined with a health savings account.

^'When you make a doctor's visit and know you are going to pay $35, you are more likely to go to the doctor. When you don't know how much it will cost you, you will put it off. ^'

- Cynthia Edson, Chandler, Ariz.

'At the beginning of 2014, most remaining measures of the Affordable Care Act will kick in, and HD Supply is keeping pace with these new compliance measures to make sure you and your family continue to have access to affordable, quality health care,' the company's enrollment package states.

Edson said her family's monthly premium will be slightly less expensive, but she and her husband will pay more out of pocket.

She said she will search for a generic cholesterol medication to replace the brand-name drugs that cost $470 for a 90-day supply. She also will ask her family's doctors how much they charge for a routine visit.

She did not have to worry about such costs with her existing plan, which charges a $35 copayment for a primary-care doctor's visit.

Health care being delayed

People have the option to decline their employer's insurance plan and choose a plan on the new government-run marketplace at healthcare.gov.

But those people will not get government subsidies if their company offers affordable health insurance, defined as costing less than 9.5% of income.

And such employees would lose their employer's contribution to their plan unless the company agreed to provide such a payment in lieu of coverage.

Edson now is planning to make sure her family does not miss out on needed health care. But she expects many others with high-deductible plans will forgo needed medical care because of pocketbook concerns.

'When you make a doctor's visit and know you are going to pay $35, you are more likely to go to the doctor,' Edson said. 'When you don't know how much it will cost you, you will put it off.'

With plans that require employees to pay a greater share of their health costs, hospitals and doctors have noticed that some consumers are delaying non-emergency procedures until they reach their deductible.

Damon Adamany, a hand surgeon with the CORE Institute in Phoenix, said his office sees a late-year surge of patients scheduling surgery for arthritis or carpal-tunnel syndrome because they have met their deductibles.

'At the end of the year, we definitely see a mad rush,' Adamany said. 'I generally don't take my vacations around the holidays. That is generally when we are the busiest.'

Yet he warns that delayed care can worsen health problems. A person with carpal-tunnel syndrome may ignore the pain, but 'the longer a nerve is being compressed, the more potential damage can be done.'

Historically, the number of patients seeking surgical procedures at the Mayo Clinic's Arizona facilities has grown 5% to 10% each year, officials said. This year, those figures have been flat.

'The way that costs are shifted with people paying a higher premium or deductible, it's had some impact,' said William Stone, who leads the clinical practice at Mayo Clinic in Arizona . 'We've seen our volumes decrease because of that.'

Experts on employee benefits say that engaging employees in their health care helps keep costs in check. Employers routinely encourage workers to take physical exams and biometric screens that gauge health risks.

Based on these measures, companies may financially reward or penalize workers.

Several surveys suggest that Americans are keeping health costs in check. Health costs routinely had double-digit increases in the past decade but have risen at moderate rates for the past three years.