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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

In photos: Life slowly returning to normal as restrictions lift across U.S.

Fireworks near the Statue of Liberty in New York City marking the end of New York State's pandemic restrictions in New York State and honoring frontline workers. Photo: Tayfun Coskun/Anadolu Agency via Getty Images

New Yorkers and Californians celebrated most COVID-19 restrictions lifting on Tuesday, as the two states became the latest to move toward fully reopening their economies.

The big picture: The pandemic has now claimed over 600,000 lives in the U.S., but vaccines have helped drive down the seven-day average to roughly 14,000 new cases and fewer than 400 deaths per day, helping most states to ease restrictions.

China's government issues warning after sending 28 planes over Taiwan

A J-11B fighter aircraft from China's air force flying over the Dafangshen airport in Changchun, China. Photo: STR/AFP via Getty Images

China's government issued a warning to "foreign forces" after Taiwan reported a record 28 Chinese military planes flew over the self-governed island's airspace Tuesday, per Reuters.

Why it matters: The warning and deployment of aircraft including fighter jets and bombers comes after G7 leaders issued a statement Sunday urging the Chinese government to respect human rights and calling on peace and "stability across the Taiwan Strait."

Southern Baptists reject push from right to elect Ed Litton as president

Photo: Win McNamee/Getty Images

The Southern Baptist Convention (SBC) rejected a push from the right in a divisive vote on Tuesday, electing a president who has prioritized racial reconciliation and approving a measure that rejects any view of racism as "anything other than sin," AP reports.

Why it matters: Ed Litton, as the new SBC president, will have the power to determine committee appointments, which can set the tone for the country's largest Protestant denomination. The SBC is comprised of 14 million members.