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California could be the first demonstration of health reform’s ability to improve a health care system. The state has a massive number of low-wage or self-employed workers (32 million) enrolled in high-deductible plans because they can’t afford higher premiums.

As we reported before, analysts at UCLA are worried high out-of-pocket costs remain tied with a reluctance to seek care. They’re also concerned the lower monthly premium is a risky trap that lures low-income individuals and families who could possibly face thousands of dollars in expenses if they have a health emergency. And the gamble gets even riskier when most participants don’t have a health savings account to help with those costs.

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