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Post-Recession Incomes Will Be Hit Hard by Health Care Spending for Middle Class Working Families, PENN Analysis Shows
Date:7/31/2009

at this conclusion by making use of a practice common among health economists. In calculating employee health care expenditures, they include not only the most obvious categories of spending -- out-of-pocket spending and premium contributions deducted from workers' paychecks -- but also forgone wages that employers instead contribute to premiums. They also include the share of income taxes that are devoted to public insurance programs such as Medicare and Medicaid. (The lay perspective typically sees employer premiums as a contribution from employers toward the cost of health care insurance, not as forgone economic opportunities for themselves).

The authors note that as family income increases, employee-paid and employer-paid premiums as a percentage of overall compensation decreases. In other words, middle-income families pay a larger percentage of their income in the form of health care premiums and forgo a larger percentage of what would have been direct income to themselves compared to upper-income families.

For example, health care expenditures, which represent 25 percent of a two-income family's total $48,000 compensation, consist of employee-paid premiums and out-of pocket expenses (8.6 percent) and health care premiums paid by an employer with wages that the family otherwise would have received, and by the government from a share of the taxes paid by the family (16.5 percent). In the case of a family with a combined income of $97,000, health care accounts for 16.7 percent of the compensation, with employee-paid premiums and out-of pocket expenses totaling 6.4 percent and employer contributions and taxes totaling 12.2 percent.

Finally, at the $175,000 level, health care accounts for 13.9 percent of a family's compensation -- with 2.6 percent being employee-paid premiums and out-of pocket expenses and 11.3 coming in the form of employer contributions and taxes.

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SOURCE PENN Medicine
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