Healthcare Spending Burdens of Employer-Sponsored Insurance Enrollees Across the Income Distribution

Almost 60% of Americans under 65 are covered by employer-sponsored insurance (ESI) plans, which are becoming increasingly unaffordable. We analyzed data from the 2022 Survey of Income and Program Participation (SIPP) to assess premium and out-of-pocket (OOP) healthcare spending burdens for ESI enrollees across income categories and healthcare spending quintiles. Burdensome spending was ubiquitous across income categories: of the 95 million adults meeting our inclusion criteria, 7.6 million (5 million with incomes ≤400% FPL; 2.6 million with incomes >400% FPL) had premium spending exceeding the 2021 Affordable Care Act (ACA) affordability threshold of 9.83% of income. Considering combined premium and OOP spending, 14.9 million adults (8.2 million with incomes ≤400% FPL; 6.7 million with incomes >400% FPL) had spending exceeding the affordability threshold. The prevalence of burdensome spending rose along spending quintiles. Our findings underscore the need for targeted subsidies and employer-led reforms to alleviate financial strain on Americans across income groups.