According to a new report from the UCLA Center for Health PolicyResearch, 3 million Californians are enrolled in high-deductiblehealth plans.

With deductibles more than $5,000, these health plans may causemembers to stall care and can put families in financial trouble ifa health problem arises, say the authors of the report, ProfilingCalifornia's Health Plan Enrollees: Findings from the 2007California Health Interview Survey. Still, high-deductibleplans are typically the only insurance many Americans, particularlyself-employed or low-income people, can afford.

Profiling California's nearly 32 million insured residents, thereport states a total of 3 million commercially insuredCalifornians were enrolled in high-deductible plans in 2007.Participating in high-deductible health plans is especially popularamong enrollees of preferred provider organizations. In fact, ofall commercial PPO members, 28 percent say they have a deductiblehigher than $1,000. Fourteen percent of commercial healthmaintenance organization plan members reporting having suchplans.

As defined by the California Health Interview Survey, high-deductibleplans have out-of-pocket deductibles of $1,000 or more forindividuals or $2,000 or more for families, and can exceed $5,000annually.

"Many Californians can't afford higher-premium plans, especiallyin the current economic climate," says the report's lead author,Dylan Roby, a Center research scientist. "But the alternative -high-deductible plans - may cost less initially but can costthousands of dollars when you need health care. When that muchmoney is on the line, a health emergency can also become afinancial emergency."

This exchange, in accordance to the federal law, will offer morerobust health coverage options and limit out-of-pocket deductiblesat $2,000 for individuals and $4,000 for families while offeringsubsidies for those with low-incomes.

"The insurance exchanges may offer a lifeline to individuals andfamilies by establishing reasonable out-of-pocket maximums forfamilies to pay," Roby notes.

The report also notes significant many low-income Californiansare likely to choose high-deductible health plans. Thirty-twopercent of low-income enrollees in commercial PPOs had those plans,and 25 percent of low-income commercial HMO enrollees and 24percent of commercial Kaiser HMO enrollees also reported choosinghigh deductible plans.

Of the individually insured, meaning those who purchasecommercial insurance directly from brokers, HMOs or PPOs, 38percent purchased high-deductible plans. For those withemployer-based plans, only 12 percent had high-deductibleplans.

Delayed treatments are found with high out-of-pocket costs. Forexample, 20 percent of commercial PPO enrollees withhigh-deductible plans were more likely to delay care than thosewithout high-deductibles at 17 percent.

Most who participate in high-deductible health plans had nohealth savings account to potentially help with the cost ofunexpected health care. Among commercially insured respondents witha high-deductible plan, 69 percent of PPO members, 77 percent ofHMO members and 80 percent of Kaiser HMOs members reported havingno health savings account for medical expenses.

The findings, the authors note, show the need for greatereducation to help consumers understand the costs and consequencesof health insurance choices.

"Consumers need information to choose the right coverage, sothey receive the care when needed, not just when they can affordit," says Sandra Perez, director of the California Office of thePatient Advocate. "Thus, it is essential that a consumer haveaccess to reliable information and helpful decision-making tools tomake an informed choice when selecting a health insurance plan."