PwC’s latest report on medical cost trend reminds us that half of families in health plans with a deductible less than $2,700 did not have enough savings to cover their share of medical expenses up to that limit. This helps explain why many enrollees with high deductibles forego or delay care. In addition, since many enrollees don’t understand their benefits, they also skip no-cost preventive visits that can help avoid more expensive care down the road.

But the flat utilization trend may mask another cost for employer plan sponsors: a forthcoming IBI report on the health and productivity challenges for lower-income workers finds that cost-related barriers to care were associated with more illness-related absences. This occurred among all employees, not just those with low incomes. This suggests that some of employers' savings from cost-shifting are mitigated by productivity losses.