If Harvard employees don't seek medical care beyond preventative services such as screenings or immunizations, which are covered at no out-of-pocket cost, they would end up with more money in their pockets this year than they would have last year, before the new charges went into effect.
Such a decrease in premiums is unusual among employer-sponsored health plans, which have tended to rise from year to year, even during a recent slowdown in health-care cost inflation. A recent report by the Kaiser Family Foundation found that the premium prices of such plans rose by an average of 3 percent in 2014.
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Chernew said "I am sympathetic" to the argument that critics have made about the effect of the deductibles on people who use more services.
"For some people it turns out to be a big deal," he said.
But, given the decrease in premiums, and other factors, "I don't think these changes have been as horrific as the outcry has been," Chernew said.
He noted that Harvard was also, in addition to tweaking its existing health plan, now offering a new high-deductible plan that has even lower premiums than those of the original plan, giving people who use few medical services added savings. The university also has a program to help offset the effect of out-of-pocket charges on employees who earn $95,000 or less.
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Chernew and other advocates of the changes also expect that imposing deductibles and co-insurance will serve as a brake on people using health services, such as imaging tests, that aren't necessarily needed. In turn, Chernew said, that could help keep insurance costs down for the university and its employees in future years.
"We had very little cost-sharing before," Chernew said.
Harvard classics professor Richard Thomas, a leading critic of the imposition of cost sharing, acknowledged there will be a reduction in premiums and possibly a cut in the total health-care costs for the majority of plan enrollees.
"There'd be a slight reduction [in premiums], in some cases it's a matter of under $10 per month," Thomas said. "It's pretty minimal."
Asked if that reduction for most people warranted imposing cost-sharing charges on a minority, Thomas said: "I don't know. But let's say 300 people end up incurring an illness that means paying $900 or $1,500 this year, next year and maybe for the rest of their lives, and those 29,700 people are paying $9 or less per month [in premiums]. Is that an ideal community?"
"What's concerned us," he said about the deductible and co-insurance charges, "is that this is, in effect, a pay cut for sick and the poor members of our community, particularly women who are planning to have families, and those are the ways that seemed regressive."