Health care cost and affordable health care are understandably at the forefront of consumer concerns as studies show rising health care spending across the nation. For over a decade, SHADAC has monitored and produced reports on health care cost and affordability trends through primary data collection and secondary data analysis. SHADAC’s work on these subjects ranges from studies involving primary data collection to assess costs of care, such as care coordination costs; to secondary data analyses of individuals who forgo needed medical care or make changes to prescription drugs due to cost; and of increasing premiums and deductibles in our annual employer-sponsored insurance report. SHADAC staff have also modeled the projected use and cost of Medicaid spending on long-term services and supports for Medicaid enrollees.
Below, you'll find examples of SHADAC projects and blogs in this area of expertise.
Related SHADAC Projects
Data and Analysis to Support a Culture of Health (DAPCoH)
The DAPCoH project, funded by the Robert Wood Johnson Foundation (RWJF), is designed to help states and organizations keep pace with the rapidly shifting health policy environment, track progress toward key goals of advancing health equity and access to needed care, and provide policymakers access to timely, high-quality state-level data to inform decision making.
A large part of this project is focused on health care costs and affordability, creating deliverables and resources that help stakeholders understand where health care costs come from, how health care costs and affordability can affect public health, and how costs and affordability can vary depending on a variety of factors (e.g., geographic location, state, demographic group, poverty level, etc.).
One interactive resource created for this project is State Health Compare, an online, free-to-access data tool with a number of measures focused on cost and affordability, including out-of-pocket spending, ESI costs, forgone care due to cost, and more. These measures use data from a variety of sources (including surveys, vital statistics data, BLS data, and more) and are available by multiple breakdowns, allowing users to delve into factors that could impact costs and affordability. Learn more about State Health Compare here.
SHADAC researchers also create a number of blogs, issue briefs, and infographics delving into the topic of health care costs and affordability. For example, one blog describes and analyzes forgone care due to cost; the analysis revealed that, in 2023, rates of forgone care for Black adults (12.7%) and Hispanic/Latino adults (20.1%) were significantly higher than the overall rate of 11.6%. We also provide annual updates to publications on housing affordability, with both blogs and infographics describing and analyzing the connection between unaffordable rents and health.
Additionally, we created a blog that examines how state household health surveys ask consumers about the topics of cost and affordability. In our scan of eight states’ surveys, we found that the majority of surveys went beyond asking about coverage rates, also exploring overall cost burdens, including premiums, deductibles, forgone care, medical debt, and more.
Analysis of Employer-Sponsored Insurance (ESI) Costs and Coverage
The majority of people (54.7%) in the U.S. receive health insurance coverage through their (or their family member’s) employer. In 2023, the number of individuals enrolled in this type of coverage, known as employer-sponsored insurance or ESI, was approximately 182.3 million people.
In order to better understand the ESI landscape at both the national and the state level, SHADAC researchers use data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC), which is designed solely to measure changes in this specific type of coverage. We use this data to analyze ESI cost trends, like premium and deductible costs, but also related topics such as high-deductible health plan (HDHP) enrollment.
We communicate our ESI analysis and findings in an annual report, blog, or infographic, allowing for comparisons of trends over time. In one of our most recent reports, we took a post-pandemic look at ESI cost and coverage, finding that premiums grew faster than the cost of living, and over half of the states (26) saw statistically significant increases in average single premiums from 2022 to 2023, and no states saw decreases. During this same time frame, 19 states saw increases in average family premiums and, again, no states saw decreases. Read that full report here.
SHADAC researchers also extrapolate data from the MEPS-IC in order to make state-level estimates for cost-related measures like average ESI deductible, percent of annual premiums contributed by employees, and high-deductible health plan enrollment available on our data tool, State Health Compare. There, users can download ESI data and compare by state, year, and more, or create unique data visualizations.
California Health Care Foundation: Health Care Cost and Affordability Research
For over 10 years, SHADAC has worked with the California Health Care Foundation (CHCF) to provide expert input, data analysis, and discussion on numerous projects and briefs. Along with work on health care coverage and access, much of our work with CHCF involves understanding health care cost and affordability for a variety of populations.
For example, in a SHADAC authored brief for CHCF, researchers analyzed data from the California Health Interview Survey (CHIS) to understand the impacts of the pandemic on health care affordability in California. Findings showed that Californians were largely protected from experiencing a major erosion in their ability to pay for health insurance and care. Specific findings included that fewer Californians reported difficulty paying medical bills, the uninsured rate declined, and the practice of using credit card debt to finance medical bills also declined. However, racial and ethnic disparities persisted, and “cost” remained Californians’ the top reason for lacking health insurance.
Assessment of Long-Term Services and Supports in Minnesota Post-Pandemic
Long-term services and supports (LTSS) includes a broad range of medical and personal care assistance that people may need when they experience difficulty completing self-care tasks, whether that is for a few weeks or many years. LTSS includes services such as nursing homes, home health care, assisted living, and more. For many years, SHADAC researchers have worked with Minnesota’s Department of Human Services (DHS) and other collaborators to better understand LTSS use and impacts in the state, including the overall costs, who is using these services (e.g., demographic groups, household types, etc.), and how policymakers can best plan and strategize for the future.
This planning is critical for both providing quality care and for Medicaid financing & state budgets: The majority of LTSS is paid for by Medicaid, at a tremendous (and growing) expense to states. In Minnesota in 2023, adults 65 and older and people with disabilities made up approximately 15% of state Medicaid enrollees, but they accounted for about 60% of Medicaid spending.
The Department of Human Services engaged the University of Minnesota School of Public Health and Purdue University School of Nursing team to conduct a study in order to assess the utilization and costs for LTSS among Minnesotans age 65 and older after the COVID-19 pandemic, as well as testing and describing several scenarios about potential future LTSS costs in the state.
Amongst other findings, the study reports that, “even though the total older population of Minnesota was growing from 2016 through 2023, rates of LTSS use per 1000 people in the older population declined steadily.” However, despite a decline in overall LTSS users and months of service use between the pre- and post-COVID periods, average monthly and annual cost per user went up: Total annual cost per person rose by 19% from $34,926 in the pre-COVID period to $41,440 in the post-COVID period.
You can find all of the products, reports, presentations, and more created as a part of this project on our LTSS resource page.
Past Work
Affordability and Access to Care: Examining Inequities Across the United States
Various SHADAC analyses examine Americans’ health care costs, access to care, and ability to afford medical care. Many of our analyses explore inequities related to race/ethnicity and education, often using measures from SHADAC’s State Health Compare, including: Adults Who Forgo Needed Medical Care, Health Insurance Coverage by Type, and Adults with No Personal Doctor. The graphic to the right, featured in one of our analyses using 2018 BRFSS data, explored inequities in health care cost and access based on race/ethnicity and education. In one of our latest publications on the topic of health care cost and affordable health care, researchers analyze Forgone Care by Coverage Type, which revealed that 63% of adults without health coverage reported forgone care while no more than 14% of those with coverage reported forgone care. Find the full analysis here; explore this and other data on State Health Compare.
State and Federal Relief Prevented Deep Backslide in Health Care Affordability in California in 2020
There were well-founded fears that the pandemic, and the concurrent economic crisis, could make health insurance and health care unaffordable for even more people — already a long-standing problem in California. This analysis of the California Health Insurance Survey (CHIS) shows that Californians were largely protected from experiencing a major erosion in their ability to pay for health insurance and care. Despite this overall positive finding, the 2020 CHIS data on health care affordability continue to demonstrate clear inequities by income and race/ethnicity.
Employer-Sponsored Insurance: A National-Level Look at Cost and Coverage Rates
Throughout the United States, a majority of Americans and their families receive health insurance coverage through their employer. In 2021, the number of individuals enrolled in this type of coverage – known as employer-sponsored insurance or ESI – exceeded 62.2 million. In this blog, infographic, and companion documents, SHADAC researchers use data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to analyze the private-sector ESI landscape in 2021 on a national level and within the states. We used the following year's data from the same source and compared 2022 vs 2021 in terms of employee access to coverage, health care cost for employees, and more in this blog and accompanying infographic.
2018 State-Level Estimates of Medical Out-of-Pocket Spending for Individuals with Employer-Sponsored Insurance Coverage
As part of SHADAC’s work monitoring trends in coverage, access, and affordability, this brief highlights the affordability of coverage for those with employer-sponsored health insurance (ESI). Using data from the Current Population Survey (CPS), SHADAC estimated family out-of-pocket costs for people with employer coverage across all 50 states and the District of Columbia (D.C.). Additional analysis looked at family median out-of-pocket costs by state and estimated the high medical cost burden where family out-of-pocket spending is greater than 10% of household income.
Minnesota Health Care Home Care Coordination Cost Study
The Minnesota Department of Human Services and Health contracted with SHADAC to conduct a study of the costs of Health Care Home care coordination for adults. In order to estimate the cost of care coordination, SHADAC used a case study approach and developed a list of activities (or “ingredients”) that define care coordination and collected information about the costs associated with each of these activities at six non-acute, primary care clinics.