The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care pro-viders, and employers. High-deductible health plans (HDHPs), often considered “blunt instruments” that indiscriminately reduce utilization of both appropriate and discretionary care, require annual out-of-pocket payments of $1,000 to $10,000 for many services before more comprehensive coverage begins.1 Unfortunately, large gaps remain in our understanding of HDHPs' effects on vulnerable populations, life-saving services, and health outcomes.
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