Posted on April 2, 2007

High Deductible Plans Penalize Women, Middle-Aged Adults, Sick Children


For Immediate Release
April 02, 2007

Steffie Woolhandler, M.D. 617-497-1268, 617-312-2766
David Himmelstein, M.D. 617-665-1032, 617-312-0970
Nick Skala 312-782-6006

A study by Harvard Medical School researchers finds that the increasingly popular high deductible health plans are discriminatory against women, leaving them with far higher out-of-pocket health bills than men. The researchers also found that adults 45-64, those with any chronic condition (such as asthma or high blood pressure) and children taking even one medication were likely to suffer financially in high deductible plans. The study, appearing in the July 2007 issue of the Journal of General Internal medicine, analyzed nationwide health spending data from the Medical Expenditure Panel Survey. The researchers calculated the median annual medical costs of men, women, various age groups, and of people with a variety of medical conditions. (Half of people spend more than the median and half spend less).

Under high deductible health plans, patients are responsible for at least $1,050 (often $5000) in medical bills before insurance kicks in. High deductible plans are a cornerstone of the new Massachusetts’ health reform; most of the newly-mandated, unsubsidized plans have deductibles of $2000, with co-payments and coinsurance after that. Such plans carry lower premiums than traditional coverage. Employers and politicians have touted high-deductible plans as a cost-saving strategy, hoping that they will make patients more cost conscious when they seek care. It has previously been recognized that young and healthy individuals stand to gain under high deductible policies, because few of them incur the high out-of-pocket costs.

The Harvard study is the first to show that most women will be financial losers under high deductible plans. In 2006, the median health costs for women age 18-64 was about $1000 higher than for men ($1,844 vs. $847). The difference was particularly striking among young adults (18-44), with median expenditures for women being nearly threefold higher than for men ($1,266 vs. $463). As expected, middle-aged adults had far higher expenses than did the young, making most of them financial losers in high deductible plans. For those aged 45-64, the median expenditure was $1,849 for men and $2,871 for women.

The researchers also found that most individuals with even mild chronic conditions were likely to suffer financially in high deductible plans. For the 26.9 million Americans with high blood pressure, median expenditure was $3,161. The median for the 9.7 million receiving any treatment for arthritis was $5,425, while the figure for the 5.2 million diabetics (on any medication) was $5,774. Strikingly, the 12.1 million children who took even a single prescription medication had median expenditures of $1,305.

Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and lead author of the study commented: “High deductible plans punish women for having breasts and uteruses. Our costs are higher than men’s because we need Pap tests, cervical cancer vaccine, mammograms and birth control, and because pregnancy is expensive. When employers raise deductibles, they’re giving women a pay cut. And when politicians offer tax breaks for high deductible plans, they’re discriminating against women.”

“High deductible health insurance penalizes anyone who’s sick. Even common, mild problems like arthritis and high blood pressure make you a loser in a high deductible plan. And these financial penalties keep people from getting the routine care they need to prevent disastrous illness later on”, said Dr. David U. Himmelstein, study co-author and a Harvard Medical School Associate Professor. “High deductible plans are mean spirited and unfair, and they won’t save our failing health system. We need to care for everyone and spread the costs over men and women, young and old, healthy and sick. We need better coverage, not the ever-skimpier plans that politicians are pushing. In short, we need national health insurance with first dollar coverage for all Americans.”

A copy of this study can be accessed at the following URL:


Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact or call 312-782-6006.