Out of 32 million insured residents in California, three million were enrolled in high-deductible health plans (HDHPs) in 2007, according to a new report from the University of California at Los Angeles.

High out-of-pocket costs caused some reluctance to seek care, the study by the UCLA Center for Health Policy Research found. For example, 20% of commercial PPO enrollees with high deductible plans were likely to delay care, compared to 17% of those without high deductibles, researchers found.

HDHPs were defined by the center as plans with deductibles of $1,000 or more for individuals or $2,000 or more for families. Some exceeded $5,000 annually in deductibles, UCLA says.

HDHPs are the only insurance many Americans can afford, especially the self-employed or those with low-incomes, the study team notes.

California enrollment in HDHPs in 2007 was highest among members of preferred provider organizations (PPOs), where 28% of all commercial PPO members reported a deductible higher than $1,000. Among commercial health maintenance organization (HMO) plan members, 14% reported having such plans.

The findings are noteworthy in light of California’s newly established Health Benefits Exchange, which will offer health care coverage to the state’s uninsured as part of the federal Patient Protection and Affordable Care Act (PPACA) enacted in March. As provided by PPACA, the exchange will offer health coverage with caps on out-of-pocket deductibles of $2,000 for individuals and $4,000 for families while subsidizing insurance costs for those with low incomes.

Significant numbers of low-income Californians in the study were likely to choose HDHPs. Of low-income enrollees in commercial PPOs, 32% had HDHPs, while 25% of low-income commercial HMO enrollees also reported choosing HDHPs.

Among the individually insured who bought their own commercial health care insurance, 38% had an HDHP, compared with 12% of those with employer-based plans.

Most of those with HDHPs had no health savings account. Among commercially insured respondents with an HDHP, 69% of PPO members and 77% of HMO members reported having no health savings account for medical expenses, UCLA found.

-Trevor Thomas