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• W154131495 abstract "As policymakers consider implementing a national mandate that everyone must hold health insurance, they face the issue of setting affordability thresholds. Mandating coverage is another way of setting a normative standard regarding a merit good. But this normative standard is informed by the current behavior of individuals and households in terms of their purchase of private coverage and health care services. Furthermore, a normative standard of affordability must be translated into an operational definition that can be easily understood and implemented. In this analysis, we use the most recent available nationally representative data to examine the distribution of out of pocket spending on health care and health insurance as a percent of family income – the financial burden of health care. We examine the distribution of burdens by poverty class, age, and family size to identify typical purchasing patterns among families in similar circumstances. Using definitions in the previous literature developed by Bundorf and Pauly, we identify the groups they refer to as “insured non-afforders” and “uninsured afforders”. While general patterns of purchasing health insurance among families in similar circumstances are important in establishing operational affordability thresholds, it is also important to look more closely at possible reasons for why “uninsured afforders” remain uninsured and why “insured non-afforders” purchase coverage. In previous work, we have introduced another variable into such analyses by accounting for household net wealth. In this paper, we also introduce health status and the presence of employer offers. In addition, we adjust our measure of financial burden by the amount of employer contributions to health insurance for those with employer sponsored coverage. We use data from the 2007 Medical Expenditure Panel Survey (MEPS) Household Component (HC) for our analyses of current behavior and then use pooled data from previous years inflated to 2007 to analyze burdens by smaller groups of similar families in terms of age, size and health and offer status. We present burden measures where the numerator includes out of pocket costs for health care services; and out of pocket costs for health care services plus health care premiums. A third measure incorporates predicted employer contributions to premiums in both the numerator and denominator. We use the MEPS Insurance Component (IC) to estimate models of employer contributions as a function of establishment characteristics, employee contributions and wage distributions. Then we use coefficients from these models to predict employer contributions for covered individuals in the MEPS HC. These national estimates can inform the implementation of affordability standards in practice. They also provide clues as to how many families will be able to afford coverage in a health insurance exchange where premiums may be subsidized." @default.
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• W154131495 date "2010-06-01" @default.
• W154131495 modified "2023-09-28" @default.
• W154131495 title "Affordability of Health Care: Recent Estimates from the 2007 Medical Expenditure Panel Survey" @default.
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