High-Deductible Health Plans Disproportionately Hurting Black Cancer Survivors

A new study finds that Black cancer survivors on high-deductible health plans face more cost-related barriers to care than white cancer survivors on the same plan, including needing to skip a medication or delay a refill to save money, and not being able to see a specialist.

Black cancer survivors on high-deductible health plans are far more likely to struggle to afford healthcare and medicine than their white counterparts, finds a new Boston University School of Public Health (BUSPH) study published in JAMA Network Open.

However, Black and white cancer survivors on other types of plans are equally unlikely to face these challenges.

The study finds that Black cancer survivors on high-deductible health plans face more cost-related barriers to care than white cancer survivors on the same plan, including needing to skip a medication or delay a refill to save money, and not being able to see a specialist.

For example, 22.8% of Black cancer survivors on high-deductible plans skipped medication to save money. That's compared to versus 8% of white patients.

But among cancer survivors on other kinds of plans, 7.7% of Black versus 5.4% of white patients skipped medication.

"As enrollment in high-deductible health plans continues to rise, this has really concerning implications for racial equity among cancer survivors," study lead author Megan B. Cole, PhD, MPH, assistant professor of health law, policy & management at BUSPH, said in a statement.

"Enrollment in HDHPs may compound the many structural inequities that Black cancer survivors are already facing, which may further drive disparities in health outcomes for survivors," Cole said. "Policies that limit deductible sizes and extend cost-sharing subsidies to high-risk groups, said limiting the types of services to which a deductible applies, may help to mitigate observed effects.

The researchers used National Health Interview Survey data from 2013 through 2018 on 3,713 adults with a past or current cancer diagnosis, and analyzed the relationships between race, health plan type, and eight common indicators of difficulty accessing care and medicine.

In addition to skipping medication:

• 24.6% of Black versus 8.6% of white patients on high-deductible plans took less medication to save money. That's compared to 8.5% of Black and 5.4% of white patients on other types of plans.
   
• 28.1% of Black versus 7.7% of white patients on high-deductible plans delayed filling a prescription. That's compared to 16.2% of Black and 7.1% of white patients on other types of plans.
   
• 14.9% of Black versus 6.2% of white patients on high-deductible plans were unable to afford to see a specialist. That's compared to 4.9% of Black and 2.9% of white patients on other plans.

According to the researchers, high-deductible plans now cover nearly one-third of all people who have employer-sponsored health insurance, and half of cancer survivors with private insurance.

Overall, the percentage of privately insured cancer survivors on high-deductible plans rose from 37% in 2013 to 50% in 2018.