{"id":69,"date":"2019-11-04T22:51:22","date_gmt":"2019-11-04T22:51:22","guid":{"rendered":"https:\/\/market-wisdom.com\/?p=69"},"modified":"2020-09-25T23:22:55","modified_gmt":"2020-09-25T23:22:55","slug":"the-middle-class-cant-afford-medical-care","status":"publish","type":"post","link":"https:\/\/market-wisdom.com\/index.php\/2019\/11\/04\/the-middle-class-cant-afford-medical-care\/","title":{"rendered":"If you\u2019re middle class you can\u2019t afford to get sick"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"840\" height=\"560\" src=\"https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?resize=840%2C560&#038;ssl=1\" alt=\"Image of doctors operation, related to the middle class can't afford medical care\" class=\"wp-image-70\" srcset=\"https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?resize=1200%2C801&amp;ssl=1 1200w, https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?w=1920&amp;ssl=1 1920w, https:\/\/i0.wp.com\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/surgery-1822458_1920.jpg?w=1680&amp;ssl=1 1680w\" sizes=\"auto, (max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><figcaption><a href=\"https:\/\/pixabay.com\/photos\/surgery-hospital-doctor-care-1822458\/\">Image<\/a>&nbsp;courtesy Sasin Tipchai\/Pixabay<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Background<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The average American household spends 8% of their budget, $4900 a year, on health care.  This cost has been rising over time&nbsp;&nbsp;(see the&nbsp;<a href=\"https:\/\/market-wisdom.com\/index.php\/2019\/10\/10\/how-americans-spend-chasing-the-american-dream\/\">How Americans Spend<\/a>&nbsp;post).&nbsp;&nbsp;However, the average cost hides a world of (financial) pain households are facing.&nbsp;&nbsp;If you get insurance through your employer (<a href=\"https:\/\/www.kff.org\/other\/state-indicator\/total-population\/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\">50% of households<\/a>) you pay less than buying on your own (7%).  However, but any household that\u2019s not on Medicare (14%) or Medicaid (21%) may be faced with some very difficult spending or saving choices given the high cost of getting care.&nbsp;&nbsp;This post explores the reality for working households and digs deeper than the averages to understand different types of consumers.   <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This analysis won\u2019t begin to look at the&nbsp;<em>why<\/em>&nbsp;of rising expenses \u2013 that\u2019s an entirely different topic.&nbsp;&nbsp;And because trying to find good data on health spending, and getting clear insurance plan comparisons, is slightly more difficult than inventing perpetual motion, treat the numbers below as a good indication of reality but not the final answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Findings<\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/market-wisdom.com\/wp-content\/uploads\/2019\/11\/Health-insurance-premium-trend-1.pdf\" alt=\"Graph showing trend in the cost of workplace health insurance, helping explain why the middle class can't afford medical care\" class=\"wp-image-73\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The short story is that many families can\u2019t really afford health care \u2013 and financial services firms do them no favors by skirting the issue in their planning tools.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I\u2019ll focus on costs for the stereotypical family of four \u2013 two parents and two children.  The analysis below&nbsp;<em>excludes<\/em> their paycheck contributions to Medicare, Medicaid and other governmental programs taxed through employment.  The short story is that the middle class can&#8217;t afford medical care!<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>A family getting insurance through an employer probably is spending north of $10,000 per year<\/strong>, because:<ul><li>The average portion of the&nbsp;<a href=\"https:\/\/www.kff.org\/report-section\/ehbs-2019-section-6-worker-and-employer-contributions-for-premiums\/\">premium<\/a>&nbsp;they share is $6,000.<\/li><\/ul><ul><li>Their&nbsp;<a href=\"https:\/\/www.kff.org\/report-section\/ehbs-2019-section-7-employee-cost-sharing\/\">deductible<\/a>, the amount they must spend before insurance kicks in, averages $3,500.<\/li><\/ul><ul><li>On top of this, plans have an out-of-pocket maximum capping the insureds\u2019 annual spending.&nbsp;&nbsp;If you\u2019re a typical family with kids breaking arms and getting sick, you\u2019re likely to exceed your deductible and then your out of pocket expenses can be thousands more.<\/li><\/ul><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>If the family is buying insurance on their own, they\u2019re looking at $25,000 or more a year<\/strong>.&nbsp;&nbsp;This assumes they are above the level of subsidy through the governmental exchanges, which is $103,000 a year \u2013 about 30% of US households.&nbsp;&nbsp;&nbsp;No average is available, but we know that the average employer plan premium is almost $21,000.  Premiums in the California insurance exchange are $15,000\/year for a basic bronze Kaiser HMO plan and $25,000 for a Blue Shield Silver PPO plan.&nbsp;&nbsp;That means that this family is likely paying in the area of $20,000+ for insurance, plus the deductible and copays.  Hence, $25K\/year may even be a low estimate.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If your income is below $103,000 subsidies kick in on a sliding scale but you still spend on care.  If your income is at the US household median of $62K\/year, the premium alone on the Blue Shield PPO will still run about $8,000\/year.&nbsp;&nbsp;Add onto this deductibles and copays and it gets expensive fast.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Costs are rising dramatically<\/strong>&nbsp;in inflation adjusted dollars:&nbsp;&nbsp;Anyone who\u2019s paid for health care in the past 20 years knows this!&nbsp;&nbsp;Per the chart \u2013 employee contributions for premiums have risen 149% while the overall premium cost was up 114%.&nbsp;&nbsp;Deductibles are harder to quantify but in 2004 only half of employer plan participants had them; now it\u2019s 85%.&nbsp;&nbsp;<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Implications<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Financial services companies like to tell middle class consumers they need to save a lot more money for retirement.  Unfortunately, they almost never talk to them about their health care situation and the tradeoffs that they face.&nbsp;&nbsp;If you make $100,000 a year pre-tax, that may equate to $75-80,000 after income tax, and you have to pay for housing, food, clothing and transportation.&nbsp;&nbsp;&nbsp;Spending $10,000 up to $25,000 or more on insurance and health care means either you forgo saving for retirement, or you go without insurance.&nbsp;&nbsp;To adequately advise consumers on how to manage their finances, you have to understand their situation with respect to health care and tailor your recommendations, instead of jumping straight in and saying \u201cjust max out your 401(k)\u201d.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most online financial planning tools offer little or no consideration of the health care cost.&nbsp;&nbsp;The reality is that in many cases, the middle class can&#8217;t afford medical care.  As an industry, financial services should be addressing health care costs head on, not skirting the issue like a dodgeball player.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">The small print<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most of the excellent data for this post came from the&nbsp;<a href=\"https:\/\/www.kff.org\/report-section\/ehbs-2019-section-6-worker-and-employer-contributions-for-premiums\/\">Kaiser Family Foundation report, 2019 Employer health benefits survey<\/a>&nbsp;which has a host of information on employer-offered health insurance plans.&nbsp;&nbsp;The inflation adjustment can be found&nbsp;<a href=\"https:\/\/www.usinflationcalculator.com\/\">here<\/a>.&nbsp;&nbsp;California\u2019s insurance exchange costs came from the&nbsp;<a href=\"https:\/\/www.coveredca.com\/\">Covered California website<\/a>&nbsp;for 2019 coverage.&nbsp;&nbsp;As mentioned above, the multitude of data sources, vast variations in insurance coverages, and general complexity of the system makes it very difficult to make perfect comparisons or cost of care calculations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/market-wisdom.com\/index.php\/sign-up-for-cool-weekly-insights\/\">Sign up for the weekly insight email!<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background The average American household spends 8% of their budget, $4900 a year, on health care. This cost has been rising over time&nbsp;&nbsp;(see the&nbsp;How Americans Spend&nbsp;post).&nbsp;&nbsp;However, the average cost hides a world of (financial) pain households are facing.&nbsp;&nbsp;If you get insurance through your employer (50% of households) you pay less than buying on your own &hellip; <a href=\"https:\/\/market-wisdom.com\/index.php\/2019\/11\/04\/the-middle-class-cant-afford-medical-care\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;If you\u2019re middle class you can\u2019t afford to get sick&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[8,1],"tags":[],"class_list":["post-69","post","type-post","status-publish","format-standard","hentry","category-how-americans-spend","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>If you\u2019re middle class you can\u2019t afford to get sick<\/title>\n<meta name=\"description\" content=\"The middle class can&#039;t afford medical care. 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