Inequality and Health in America

While the top one percent of earners in the United States were doubling their share of total income over the past 30 years, middle- and lower-income families were losing their access to affordable health insurance. Rapidly rising health-care costs coupled with expanding job losses have left millions of American families exposed to potential economic crisis when faced with illness or injury. The number one cause for bankruptcy in the U.S. is an unexpected health crisis. The following statistics tell the story.

Between 2000 and 2010, the average cost of employer-provided family health insurance coverage rose from $6,438 to $13,770–an increase of 114 percent. The amount workers had to contribute towards this insurance coverage grew by 147 percent, as employers shifted an increasing share of the cost of coverage onto the worker.¹

s not only had to pay more for health insurance, but the value of that coverage declined as well. Between 2003 and 2010, the average deductible attached to that coverage increased 83 percent, while out-of-pocket spending on health care increased by 74 percent,³over and above the higher contribution workers made to obtain that coverage.

Even worse, with the unemployment rate more than doubling between 2007 and 2010, many families have lost their health insurance altogether. While some of the newly unemployed qualify for Medicaid or other public coverage, 1.1 million Americans become uninsured for every one-point rise in the unemployment rate.⁴

Inequities in the cost of health care and health insurance are unfortunately only part of the story. Economic inequality brings with it iequality in health outcomes, independently of access to health care. A 25-year-old American with income more than four times the poverty level will live, on average, five years longer than a 25-year-old with income less than twice the poverty line.⁵ Those with a college education are three times as likely to report excellent or very good health status as those who did not finish high school.⁶ Those with less than a high school degree are twice as likely to experience coronary heart disease as those of the same age who have graduated from college.⁷ Money and education secure not just more life but a healthier one as well.

We find similar disturbing health disparities among different racial and ethnic minority groups, even when controlling for income and education. At all levels of education, black men and women on average report worse health than non-Hispanic whites of the same gender and level of education. Similarly, the average additional life expectancy of a 25-year-old black American is between two and four years shorter than a 25-year-old white American with the same level of income.⁸

The rising level of economic inequality in recent years has had a devastating impact on the health and access to affordable care of middle- and lower-income American families. Our efforts to reverse the growth of inequality must identify policy approaches that will both constrain the rising cost of health care and expand its availability. Parallel to these efforts, we must also identify ways to aid those Americans who would otherwise suffer declining health and life spans as a result of these disparities.

Notes (please click the footnote number to return to your place in the text):

1) Kaiser Family Foundation and Health Research and Education Trust. “Employer Health Benefits 2010 Annual Survey,” Summary of Findings, p. 1.

2) The Commonwealth Fund. “State Trends in Premiums and Deductibles, 2003–2010: The Need for Action to Address Rising Costs.” November, 2011, p. 6.

3) Rand Corporation. Rand Health Research Highlights. “How Does Growth in Health Care Costs Affect the American Family?,” p. 2.

4) Center for American Progress Action Fund. “Health Care in Crisis: 14,000 Losing Coverage Each Day.” February 19, 2009.