Editor's Note
May 28, 2024
Health Care Expenses and Household Resources for Families With Low Income
Mitchell H. Katz, Raegan W. Durant, Deborah Grady
JAMA Intern Med. Published online May 28, 2024. doi:10.1001/jamainternmed.2024.1473
Families must juggle many different expenses, including housing, utilities, food, transportation, medical care, and child care. When any of these expenses eat up too much of a family’s budget, there is a problem. This is particularly a problem for families with a low income because many expenses are not proportional to income.
In this issue of JAMA Internal Medicine, Shashikumar and colleagues1 illustrate these principles in their investigation of total health care spending for insured persons (premiums and out-of-pocket medical and prescription costs) based on data from the 2007 to 2019 Medicare Expenditures Panel Survey. They found that families with low income (those with an annual income <200% of the federal poverty level) spent 23.5% of their postsubsistence income (income minus food costs) on health care in 2007, rising to 26.4% in 2019. Health care costs also rose as a proportion of income for families with a higher income from 5.4% to 6.5% but represented a much more manageable proportion of family resources.
The results of this analysis are particularly striking, as they demonstrate the large proportion of income dedicated to health care among families with a low income but private insurance who on paper might appear to have adequate coverage of their health care costs. Even among the privately insured, many of whom receive employer-sponsored coverage, families with a low income may face daunting financial challenges in covering the total costs of health care. Moreover, we do not know how many families with a low income, with theoretical access to coverage, actually forego health insurance and health care to pay other expenses. Conversely, we do not know what was sacrificed to pay for health care costs among privately insured families with a low income. What does seem apparent is that privately insured families with a low income would benefit from greater subsidies for health insurance premiums and lower out-of-pocket costs. Although we usually focus health reform efforts on uninsured families or those relying on publicly subsidized insurance (eg, Medicaid), privately insured families with a low income also need remedies to ease the financial burden of their health care.
