Health Care Affordability: The View from the Kitchen Table

People assume that it’s hard to find any areas of agreement when it comes to the health care debate. After all, Congress and Washington DC are in gridlock, largely along partisan lines, with little chance for meaningful progress on health care on the immediate horizon.  

However, there is one major point that the most Americans can agree on: health care costs too much. Over half of the respondents to a Gallup poll earlier this year reported that they worry “a great deal” about the “availability and affordability of health care.” Approximately two-thirds of respondents are either somewhat or very dissatisfied about the affordability of health care.  

But what does “affordable” really mean? Every person will define affordability differently, reflecting their own experiences, preferences, and values.  Elected officials can debate policy solutions — each promising that their preferred approach will make health care more “affordable”– all while defining that goal in completely different ways.  

A new brief released today with our research partner Penn LDI discusses different ways to define health care affordability: as an economic concept, as a threshold established in law by policymakers, and, most importantly, the kitchen table perspective. One thing is clear: any of these lenses will reveal, albeit in different ways, significant affordability issues for many Americans. Whether it’s a worker whose pay increases go immediately to cover the rising cost of health insurance provided by his or her employer, a middle class family earning too much to qualify for tax credits to cover their health insurance premiums– and still facing a large deductible even after paying premiums, a lower income worker who strains to cover both necessities and health care expenses, or a person with a chronic or expensive health condition, health care costs are a burden for many.  

Of all the ways to approach health care affordability, the most familiar to the average American family– and the most critical to our work at United States of Care – is the kitchen table view. When people need health care, they don’t view it in the way an economist or policymaker might. People don’t think about the percentage of their household income that a federal statute or regulations believes they can contribute to their care or how much of their potential take home pay goes instead to pay their health insurance premiums. If a child is diagnosed with a serious medical condition, a parent’s reaction is likely not a rational one, but instead is based on emotion. They don’t think about what they can “afford.” They instinctively know they will do whatever it takes–giving up whatever they need to– in order to make sure their child has the best care. People don’t approach these dilemmas as Republicans or Democrats, but as parents, sons, daughters, neighbors, and friends. They just want to know they can take care of themselves and their families if they get sick.

Applying this kitchen table perspective offers valuable lessons.  Health insurance alone does not guarantee that people can afford the care they need. With about 43% of people under age 65 now enrolled in high deductible plans, an increasing number of people face the upfront financial barrier of a deductible before accessing any medical care, increasing their chances of foregoing care due to cost.  Even with comprehensive insurance, people can face surprise medical bills when they unknowingly receive care from an out of network provider, often at a hospital or health care facility that is in their insurance network. These surprise bills are a growing fear, with a recent Kaiser poll showing that respondents are more worried about an unexpected medical bill than they are their insurance deductible, prescription drug costs, health insurance premiums, or other necessities like rent and gas.

Health care policy is loaded with tradeoffs at every step, and making something more affordable for some often comes with costs, either hidden or not, to others. Policymakers, especially when promising seemingly easy solutions that they claim will make health care more affordable for everyone, should think first about the conversations that go on around kitchen tables, and whether their proposed solutions will help the people who need it.  

Will a family that is skipping care because they can’t afford their deductible be able to use their insurance without worrying about upfront costs? Will a family’s insurance cover what they need, and protect them from unexpected bills? Will those with lower incomes or costly, ongoing medical needs be better positioned to afford this care, without sacrificing other necessities? Or does a proposal make health care less expensive and more available to those who are already able to get it with minimal challenges — leaving others behind?

Our work at United States of Care is driven by the principle that everyone should have an affordable, regular source of health care. There are many different ways to talk and think about affordability, but to us, the kitchen table view — the way Americans experience the health care system — is the most important guide.