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Who Will Have Health Insurance in the Future?

Who Will Have Health Insurance in the Future?

Abstract and Introduction


The passage of the 2010 Patient Protection and Affordable Care Act (PPACA) in the United States put the issues of health care reform and health care costs back in the national spotlight. DeVoe and colleagues previously estimated that the cost of a family health insurance premium would equal the median household income by the year 2025. A slowdown in health care spending tied to the recent economic downturn and the passage of the PPACA occurred after this model was published. In this updated model, we estimate that this threshold will be crossed in 2033, and under favorable assumptions the PPACA may extend this date only to 2037. Continuing to make incremental changes in US health policy will likely not bend the cost curve, which has eluded policy makers for the past 50 years. Private health insurance will become increasingly unaffordable to low-to-middle–income Americans unless major changes are made in the US health care system.


Health care inflation slowed during the managed care era of the late 1990s, but it rose sharply after the public backlash against managed care caused many employers to abandon that model. The sharp increase in health insurance premium inflation that started around 1999 was coupled with declining inflation in household incomes. This mismatch in rate trends is displayed in Figure 1. As has historically been the case when health reform policies are being debated by the United States Congress, the annual rate of inflation for health insurance premiums in 2009 to 2010 slowed to the lowest level since the late 1990s.[1–3] Despite this slowing, the annual inflation rate of health insurance premiums still outpaced US household earnings, which stagnated from 2008 to 2011 and included an absolute reduction in average household income from $50,300 in 2008 to $49,800 in 2009.[4]


Click to zoom

Figure 1.

Percentage of change in median household income and family health insurance premium rates in the United States.

Figure 1.

Percentage of change in median household income and family health insurance premium rates in the United States.



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Authors and Disclosures

Richard A. Young, MD1 Jennifer E. DeVoe, MD, DPhil2

1John Peter Smith Hospital FMRP, Fort Worth, Texas
2Department of Family Medicine, Oregon Health Sciences University, Portland, Oregon

Conflicts of interest
Authors report none.

Corresponding Author
Richard A. Young, MD John Peter Smith Hospital FMRP 1500 S Main Fort Worth, TX 76104