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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

Miriam Kramer, author of Space
7 hours ago - Science

China makes history with successful Mars landing

A model of the Tianwen-1 Mars rover is displayed during an exhibition at the National Museum of China in Beijing. Photo: Wang Zhao/AFP via Getty Images

A Chinese lander carrying a rover successfully touched down on Mars for the first time, state media reports.

Why it matters: This is the first time China has landed a spacecraft on another planet, and it launches the nation into an elite club of only a few space agencies to successfully make it to the Martian surface.

8 hours ago - World

UN: 10,000 Palestinians displaced in Gaza as Israel-Hamas fighting escalates

A Palestinian woman walks after she collects her belongings inside her damaged house following an Israeli air in the northern Gaza Strip. Photo: Ahmed Zakot/SOPA Images/LightRocket via Getty Images)

The United Nations warned Friday that ongoing fighting between Israel and Hamas "has the potential to unleash an uncontainable security and humanitarian crisis," in not only the occupied Palestinian territories and Israel, but "the region as a whole."

The big picture: More than 125 Palestinians, including 31 children have been killed in Gaza since fighting began Monday, per the Palestinian Ministry of Health. Eight people, including two children, have been killed in Israel, Reuters reported, citing Israeli authorities.