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Health care affordability got worse, then better, then worse, over two decades

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Researchers examine trends for adult women and men before COVID-19 pandemic.

Health care affordability was getting worse, then got better, then got worse from 2000 to 2020 for people with employer-sponsored insurance plans.

The findings were part of a research letter published in JAMA to examine trends for American adults aged 19 to 64 years who obtained their health care coverage through employers or unions. Researchers Avni Gupta, BDS, MPH, and Jose A. Pagan, PhD, found women had it worse for health care affordability in the 20 years before the COVID-19 pandemic.

In 2019, 61% of U.S. adults in that age range had health insurance through an employer-sponsored plan. The study group included 238,852 adults, split between 127,192 women and 111,660 men.

They reported health care unaffordability increased from 2000 to about 2009-2010. The study group reported costs became more affordable from about 2010 to about 2017, and after 2017, unaffordability rose again.

The researchers noted the federal Affordable Care Act extended health insurance coverage to uninsured young adults, while eliminating cost sharing for some preventive services and boosting coverage for maternal care, the researchers said. But more recently, rising costs, high-deductible plans, and increased out-of-pocket spending may have made health care less affordable, the researchers said.

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The trends generally followed across medical care and dental care for women and men. Women saw a spike in unaffordability of mental health care after 2018, but for both groups, prescription drug affordability generally got better after 2010.

“For both women and men, the trends (for most services) changed from increasing unaffordability to decreasing and then to increasing again,” the study said.

The research letter noted unaffordability was higher for women than men across all services, while earlier research showed women often have more health care needs than men, along with challenges to accessing and affording health care.

“Employer-sponsored insurance benefits may need to be redesigned to reduce sex differences in health care unaffordability,” the study said.


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