Out of Pocket: Surprise Costs After Health Reform


HEALTH INSURANCE PREMIUM HIKES have been modest in recent years, but out-of-pocket costs are another story. Deductibles have on average tripled over the past decade as employers steadily shift more health costs onto workers amid stagnating wages. Health advocates fear high costs will lead people to ration or defer essential care. And the problem of out-of-pocket costs is not limited to deductibles. Patients undergoing routine surgery may wake up to surprise bills when out-of-network doctors are called into the operating room. And consumers insured through Obamacare exchanges can find themselves overspending due to deductibles that typically exceed $5,000 for a bronze plan. This webinar will help reporters and policy makers understand and quantify out-of-pocket costs and the economic forces behind them, while highlighting opportunities for compelling stories about families feeling the squeeze.

Webinars are free and made possible by the National Institute for Health Care Management Foundation

The Health Matters Webinar series is supported by the National Institute for Health Care Management Foundation. The Center for Health Journalism is solely responsible for the selection of webinar topics and speakers.


Larry Levitt

Larry Levitt is Senior Vice President for Special Initiatives at the Kaiser Family Foundation and Senior Advisor to the President of the Foundation. Among other duties, he is co-executive director of the Program for the Study of Health Reform and Private Insurance. He previously was editor-in-chief of kaisernetwork.org, the Foundation’s online health policy news service. Prior to joining the Foundation, he served as a senior health policy advisor to the White House and Department of Health and Human Services, working on the development of President Clinton’s Health Security Act and other initiatives. Earlier, he was the special assistant for health policy with California Insurance Commissioner John Garamendi, a medical economist with Kaiser Permanente, and served in Massachusetts state government. He holds a bachelors degree in economics from UC Berkeley, and a masters degree in public policy from Harvard’s Kennedy School of Government.


Noam N. Levey

Noam N. Levey writes about national health care policy for the Los Angeles Times out of Washington, D.C. He covered passage of the 2010 Affordable Care Act and has written extensively about the landmark law and reported on its implementation from around the country. Prior to joining the Times in 2003, Levey was an investigative reporter for the San Jose Mercury News in Silicon Valley. He has also written for Health Affairs and the Journal of the American Medical Association. A Boston native and a graduate of Princeton University, Levey reported for the Times from Washington since 2006.


Blair Hickman

Blair Hickman is the audience editor for The Marshall Project. Previously, she was a community editor at ProPublica, where she used engagement tactics to aid reporting on investigations into patient harm and unpaid internships. Prior to that, she worked on digital strategy at the Solutions Journalism Network. Hickman has a BA in nonfiction writing from Brown University and a master’s degree in digital journalism from NYU.

Read our summary of the event here: 

"Webinar Recap: How to report on the rising problem of out-of-pocket health care costs," by Kellie Schmitt


Larry Levitt's webinar slides:

Noam Levey's webinar slides:

Blair Hickman's webinar slides:


Suggested reading & resources

"This study is forcing economists to rethink high-deductible health insurance," by Sarah Kliff, Vox

Health Insurance Deductibles Outpacing Wage Increases, Study Finds,” by Reed Abelson, The New York Times

Healthcare costs rise again, and the burden continues to shift to workers,” by Noam Levey, Los Angeles Times

How the debate over healthcare is changing — just in time for the 2016 election,” by Noam Levey, Los Angeles Times

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know,” by Elisabeth Rosenthal, The New York Times

California takes a swipe at 'surprise' medical bills,” by Michael Hiltzik, Los Angeles Times

Despite setbacks, health advocates push for solutions to surprise, out-of-network billing,” by Kellie Schmitt, Reporting on Health

Employer Health Coverage for Family Tops $17,000,” by Anna Wilde Mathews, WSJ

"Unable to Meet the Deductible or the Doctor," by Abby Goodnough and Robert Pear, The New York Times

"Some Health Plans Have No In-Network Doctors In Key Specialties," by Alison Kodjak, NPR

2015 Employer Health Benefits Survey,” Kaiser Family Foundation

"Nearly Half Of Families In High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden," Health Affairs 

"What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," by Zarek C. Brot-Goldberg et al., NBER Working Paper

Paying Till It Hurts – Public Group on Facebook, The New York Times

Out-of-pocket Maximum Limits on Health Plans, Obamacare Facts 

Resources from Consumers Union & Consumer Reports

How Blair Hickman used 'callouts' and engagement tools to find sources for ProPublica's patient harm investigation, Reporting on Health