Employer-sponsored health insurance premiums grew more slowly in 31 states and the District of Columbia between 2010 and 2013, following passage of the Affordable Care Act. But because wages have grown even more slowly over this period, average annual premiums—including both the employer and employee contributions—by 2013 represented 20 percent or more of household income in 37 states, compared to just two states in 2003.

That is the conclusion of a new Commonwealth Fund report that analyzes trends in premium and deductible growth state-by-state over a 10-year period. A companion analysis to an earlier Commonwealth Fund report on national premium trends, the new report finds that in every state, health insurance costs grew faster than income. Workers in Southern states, where median incomes are lower than elsewhere in the U.S., face the highest cost burdens.

In every state, employees’ contributions to their health insurance premiums in 2013 amount to a higher share of state median income than a decade earlier. In 15 states, employees’ annual payment for their share of premiums rose by 100 percent or more.

Potential out-of-pocket costs for healthcare also increased markedly: deductibles doubled or more in all but six states and the District of Columbia since 2003. As a result, workers’ out-of-pocket costs for premium contributions and deductibles in 2013 accounted for a higher percentage of median income in all states compared to 2003. The combined costs ranged from 6 percent to 7 percent of median income in the District of Columbia, Hawaii, and North Dakota, to 12 percent or more in Texas and Florida.

Eight in 10 workers with employer coverage now have a deductible, and more workers are also facing high deductibles. In 2003, no state had an average deductible of as much as $1,000. By 2013, however, average per-person deductibles exceeded $1,000 in all but three states and the District of Columbia.

“This report shows that national patterns of growing health cost burdens on workers are mirrored in every state,” said Commonwealth Fund President David Blumenthal, M.D. “Out-of-pocket costs are up in most states and incomes are not keeping pace. This is of concern, since research shows that high healthcare cost burdens relative to income may lead people to avoid seeking needed healthcare.”

The report is available here.

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access