WASHINGTON - Jim Voigt has health insurance, but he can't afford to go to the doctor.

That's because the 59-year-old small-business man from Rice, Minn., has a high-deductible health insurance policy that requires him to pay $10,000 in medical costs before any coverage kicks in.

"I'm worried about the preventive stuff I avoid and should not," said Voigt, who sharpens and restores industrial saw blades for a living.

He's one of nearly half a million Minnesotans with high-deductible policies, which offer lower premiums but higher out-of-pocket expenses. According to a new survey, the state ranks second in the nation in the percentage of insured people carrying high deductible policies.

Champions of such policies say they are a way to provide affordable catastrophic coverage while forcing consumers to confront the high cost of health care.

"I don't want to be the mean professor, but insurance means covering high-cost, low-probability events," said Steve Parente, a health insurance expert at the University of Minnesota. "Prevention didn't used to be in the equation. We call it insurance, but we expect first-dollar coverage."

Critics say high-deductible policies encourage people to forego needed care and run the risk they may later need more expensive treatments that will drive them into financial distress.

"You're gambling with the important issue of your health," said Dr. Sidney Wolfe, director of health research at the universal care advocacy group Public Citizen.

The numbers suggest that high-deductible policies that were once a hedge for the healthy against medical disasters have now become the insurance of last resort for cash-strapped consumers.

The just-released survey by the advocacy group America's Health Insurance Plans (AHIP) shows an explosion in the number of Americans covered by high-deductible health insurance. Nationally, the number grew from 1 million in March 2005 to 13.5 million in January 2012.

The percentage of Minnesotans enrolled is 14.3, nearly twice the national average.

The insurance industry calls this a sign of informed consumers making economic and medical decisions that serve them best.

Advocates of universal health coverage see the proliferation of high-deductible policies as an "epidemic" driven by tough economic times and shrinking employer contributions to health insurance.

"The benefits of high-deductible policies are largely to the [health insurance] companies," said Public Citizen's Wolfe. "They cut out lots of what [companies] have to pay. It's a matter of shifting the burden for an illness from the insurance company to the patient."

An online comparison of 31 high-deductible health insurance plans in Minnesota showed a range of options. For instance, a fictional family of four with a 40-year-old dad, a 41-year-old mom, a 13-year-old son and a 9-year-old daughter can be insured for as little $268.36 a month. But that comes with a $30,000 annual deductible and co-payments even after coverage kicks in.

For $764.53 a month in premiums, there was a policy with a $3,000 deductible and no co-payments.

It is a matter of cash flow. "It's cheaper to go with the high deductibles and low premiums," said Marty Anderson of Maple Grove.

Anderson, who has a $2,500 deductible policy, said he crunched the numbers with his wife based on their medical expenses the year before. They decided they would actually save money on day-to-day medical costs and still be covered for disasters.

"The hard part," he said, "is when you walk into the doctor's office and shell out $200. I can see people avoiding going to the doctor and getting worse."

Kasey Kelly works in a cereal plant in Faribault. The 34-year-old had to choose between a low-premium, high-deductible health plan for himself and his daughters, ages 4 and 2, or a regular health plan. The regular plan premiums were "a lot more," he said, "about $100 a paycheck." So Kelly took out a policy with much cheaper premiums and a $4,500 deductible.

"I'm just gambling on the fact that I'll be healthy," he said. "If my daughters are sick, I bring them in. Me? I've had a cough for months now."

At his saw-sharpening business in Rice, Voigt can relate. His wife's job once provided health insurance for the family. When she died a decade ago, Voigt faced unaffordable premiums for COBRA, the supposed safety net health insurance for those who lose employer coverage.

"About $395 a month is all I can afford [for premiums]," Voigt said.

Ten years ago, that bought him health coverage with a $5,000 deductible. The policy came, as most do, with a tax-free health savings account that allows policyholders to save money to pay for deductibles in the event of an illness or accident.

"Once I had saved $5,000, I was covered," Voigt said.

But as premiums climbed for the $5,000 deductible policy, Voigt could no longer afford them and had to settle for a policy with a $10,000 deductible.

Meanwhile, he rarely has the cash for the out-of-pocket expense for routine care. "I've barely been to a doctor since my wife died," he said.

Jim Spencer • 202-408-2752