Health insurance is consuming 10% or more of median family income in 19 states, according to a new Commonwealth Fund analysis, underscoring how affordability pressures are building for working families even when they have employer coverage. The burden is heaviest in Southern states, with Louisiana at the top end of the range, while Washington, D.C. is at the low end. As policymakers increasingly debate consumer protection and affordability, New York continues to set the tone nationally on cost and access issues, and other states are likely to take cues from how it frames and responds to rising household financial strain tied to essential services like health care.
What the data shows
- Combined premium contributions and deductibles for family coverage reached 10 percent or more of median household income in 19 states in 2024, averaging just over 10% nationally.
- The share of income devoted to these costs ranged from 15.6% in Louisiana to 5.7% in Washington, D.C.
- Premium contributions alone exceeded the Affordable Care Act’s affordability threshold in five states: West Virginia, Mississippi, North Carolina, Florida, and Louisiana.
- In roughly half of the states, deductibles for single coverage equaled 5% or more of median individual income, a level often associated with underinsurance and higher risk of delayed care and medical debt.
Why this matters for household finances: Most working age Americans, about 167 million people, rely on employer sponsored coverage. While employers pay roughly 70% of family premiums, employees still contributed an average of more than $7,200 annually in 2024, before accounting for deductibles, copays, and coinsurance. With health benefit costs projected to rise again in 2026, driven by hospital consolidation, labor shortages, higher drug prices including GLP 1 medications, and increased demand for behavioral health care, more households are likely to feel squeezed.
The bottom line
