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Thanksgiving is always a time to think about those in need. How about, then, a group we don't worry about enough: the many lower and moderate income Americans who can't cover their cost sharing if they get sick? It raises the question: How much cost sharing is too much?

Expand chart
Reproduced from Kaiser Family Foundation analysis of the 2016 Survey of Consumer Finance; Note: Liquid assets include the sum of checking and saving accounts, money market accounts, certificates of deposit, savings bonds, non-retirement mutual funds, stocks and bonds. Chart: Axios Visuals

The bottom line: High deductible plans, which require people to pay large amounts out of pocket before their medical bills are covered, are a good deal for some middle and upper income people. But many lower and moderate income Americans simply don't have $1,500 to $3,000 to pay for the colonoscopy that might save their life, or a stress test that might reveal the heart disease which is the cause of their chest discomfort.

The details: The chart, drawn from a new study, tells the tale: More than four in in 10 households with private coverage and incomes between 150% and 400% of the federal poverty line do not have enough liquid assets to cover a deductible of $1,500 for single people and $3,000 for families.

  • That's not a high deductible plan, but about the average in an employer-provided insurance plan.
  • Sixty percent couldn't cover deductibles double those amounts, which are not uncommon, especially in the individual insurance market.
  • Ninety percent of insured households with incomes of 400% of poverty or more could meet a typical employer insurance deductible, but just 37% of lower income household with incomes under 150% of the poverty level could.

For many families, even if they have insurance, any significant illness could wipe out all their savings, making impossible to fix a broken car to get to work, or pay for school, or make a rent or mortgage payment.

Congress has passed no law declaring that the country will go with high deductible coverage as its main approach to health insurance. There has been no meaningful debate about its pros and cons. But as deductibles and other forms of cost sharing have inched up year by year, the nature of insurance has changed.

The people to worry about most are the ones who are least equipped to deal with that change. There may be someone who fits that bill around your Thanksgiving table.

Go deeper

California wildfire explodes in size, destroys historic town

Battalion Chief Sergio Mora looks on as the Dixie fire burns through downtown Greenville, Calif. on Aug. 4, 2021. Photo: Josh EdelsonAFP via Getty Images

The small Sierra town of Greenville, California, was heavily damaged on Wednesday night into early Thursday as the Dixie Fire surged northward amid high winds, extremely dry air and hot temperatures.

The latest: The Dixie Fire, California's biggest blaze, continued to threaten communities in Plumas County into Thursday night, as more mandatory evacuation orders were issued in the region.

Updated 3 hours ago - Politics & Policy

Top labor leader Richard Trumka dies unexpectedly at 72

Photo: Samuel Corum/Getty Images

AFL-CIO president Richard Trumka, who led the largest federation of unions in the country for over a decade, has died at 72.

The big picture: Trumka began working as a coal miner in 1968 and would go on to dedicate his life to the labor movement, including as president of the 12.5 million-member AFL-CIO beginning in 2009.

Biden signs bill awarding Congressional Gold Medals to officers who responded to Jan. 6 attack

President Biden, joined by Vice President Harris, lawmakers and members of law enforcement and their families, signs legislation to award Congressional Gold Medals to law enforcement in the Rose Garden. Photo: Win McNamee/Getty Images

President Biden signed legislation awarding Congressional Gold Medals to the law enforcement officers who defended the Capitol during the Jan. 6 insurrection.

Why it matters: The Congressional Gold Medal is Congress' "highest expression of national appreciation," notes the New York Times.