To the Editor Dr Emanuel and colleagues1 highlighted the great burden of health care costs on US families with their proposed Affordability Index and Comprehensive Affordability Index.
An additional challenge pertains to the rise of plans requiring high out-of-pocket costs. Suppose all individuals with employer-sponsored insurance are enrolled in high-deductible health plans on January 1, 2018. Presuming a large share of lower premiums is not offset with higher wages—at least in the short-term—the proposed Affordability Index would likely show a marked improvement. However, such an improvement would be misleading. High-deductible health plans have advantages in that they lower premiums and total health expenditures. For those patients with high clinical needs, however, high out-of-pocket costs may make essential health care services unaffordable.
Buxbaum JD, Cohen AJ, Fendrick AM. Measures of the Burden of Medical Expenses. JAMA. 2018;319(15):1621. doi:10.1001/jama.2018.1315
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