The Affordable Care Act may be guaranteeing health coverage for millions of Americans, but the definition of affordability is under dispute and raising questions about the burden on middle class consumers.
From 2010 to 2013, there was a great slowdown in employer-sponsored health plan premium increases in 31 states, yet another trend of employees having to pay more in their share of premiums and in their deductibles, the Commonwealth Fund has found.
In all but a few states, average deductibles for employer-sponsored health plans at large and small firms have more than doubled over the past decade.
"Workers are paying more but getting less protective benefits," write Commonwealth Fund researchers Cathy Schoen, David Radley, and Sara Collins. With coverage and premiums growing still, "securings low cost growth for workers, families, and employers will likely require action to address rising costs of medical care services."
Workers' costs are especially high in the American South, where income is below the national average but costs are healthcare are not necessarily so, Schoen and colleagues found.
In Florida and Texas, the average worker with a job-based health plan devoted more than 12 percent of their income to health insurance premiums and deductibles in 2013. As a percentage of median income, Floridians and Texans paid 24 percent and 25 percent of their income to premiums, according to the study. In 12 Southern states, the average total premiums equaled at least 22 percent of median incomes.
Nationally, the trend is also high, as a map from the study shows.
With deductibles, workers pretty much everywhere are facing higher thresholds before their health plans kick in. High deductibles either are the norm or are becoming it.
In every state except Arkansas, Alabama, Hawaii, Louisiana, Mississippi and Wyoming, deductibles have doubled since 2003, and increased on average by 146 percent.
In 2010, deductibles averaged at least $1,000 in 29 states. By 2013, average deductibles exceeded $1,000 in all but three states and the District of Columbia. In Connecticut, Maine, Montana, New Hampshire, South Dakota, Texas and Vermont, average deductibles were more than $1,500, the study found.
The Commonwealth Fund data suggest that the recent slowdown in premiums at employer-sponsored plans is coming in large part from companies passing on more costs to their workers.
Paying more for premiums, for a health plan with a higher deductible, is enough to make a middle income worker wonder about the value of their employer-based insurance -- and whether they'd be better off if they had a choice in the matter shopping on the open or subsidized individual market.
Low-income Americans now have access to comprehensive insurance, through Medicaid or subsidized exchange plans, and are eligible to have their total healthcare costs capped at a sliding scale starting at 6 percent of income for lowest brackets.
For Schoen and colleagues at the Commonwealth Fund, a key question in the new ACA era is how to ensure affordability through the ranks of working lower income and middle income populations -- how to slow healthcare cost growth without eroding benefits.
"This will likely require concerted efforts that span the private and public sectors," they write, hinting at state and federal regulations being conceived. "The challenge to policy leaders will be to pursue reforms that improve the quality of healthcare, rein in cost growth, and ensure that savings are shared with patients and families across the income spectrum."