Spicer is rounding up — a lot. The Affordable Care Act actually implemented a cap on the out-of-pocket costs that a plan could offer, with deductibles and other out-of-pocket costs maxing out at $7,150 for an individual and $14,300 for a family for 2017.
Looking hard at the numbers suggests that few people are even in the general ballpark Spicer described. Cox said that about a quarter of people who signed up for health care coverage in the marketplaces in 2016 are in the cheapest bronze plans, which carry the highest deductibles. Looking across all bronze plans with this year's data, only 18 percent have deductibles in the $14,000-plus range for a family — making it unlikely that many people face a deductible that high, argued Cynthia Cox, associate director of a program focused on health reform and private insurance at the Kaiser Family Foundation.
“That would be the maximum that a deductible could be, although in many cases people are getting lower deductibles than that,” Cox said, pointing out that the most popular plan in the marketplace are silver plans, which would have lower deductibles.
And on top of that, about 59 percent of all enrollees in the marketplaces in 2016 got cost-sharing subsidies that lower their deductibles significantly, depending on their income.
Cox pointed to a Kaiser analysis which showed that a silver plan deductible that was typically $2,556 would be reduced to $229 if a person's income was less than 150 percent of the federal poverty level, for example.
If there are people paying a $20,000 deductible out there, one possible reason is because the plan predates the Affordable Care Act's protections, and was allowed an exception from the rules. There is another possible scenario that Spicer could have been describing. The cap pertains only to health benefits that are actually covered by a patient's health plan. That means patients could face higher costs if they receive care from doctors or hospitals that are not in their network. Many of the plans in the exchanges have narrow networks, which means that in some areas it is relatively easy for a person to unexpectedly receive care that is not covered by their plan or covered less generously -- something called "surprise billing."
Deductibles are definitely a growing financial burden for patients — and a big concern for people who worry they could cause people to skip necessary care. A Kaiser Family Foundation health tracking poll found that in 2017, 43 percent of insured people reported finding it difficult to afford the deductible, compared with 34 percent in 2015. That was more people than reported having financial trouble with premiums or copays.
The frustration Spicer described with high-deductible plans is accurate, if not the dollar figure. But what is far less clear is whether the Republican plan would offer relief. If anything, the Congressional Budget Office warned that the GOP bill would, if implemented, increase deductibles.