Research continues to raise questions about the true affordability of health insurance available through the public exchange markets. A new study investigated the percent of household income that various demographic groups spend on medical care and, even with exchange insurance, the cost was often substantial.

The study, by an Urban Institute research team, showed that it was not just very low-income people with Obamacare insurance who were spending a high portion of household income on medical care. For instance, older Americans with exchange coverage were spending close to a quarter of their income on medical costs. The percentage was particularly high among those with serious medical problems.

But even people in middle income ranges were often spending nearly 15 percent of income on medical care.

The burden of medical care ranged from about 10 percent to nearly 25 percent within the study group. In any case, researchers said, the cost was too high and could discourage such individuals from getting insurance in the future. Their recommendations were to further adjust the balance between premiums, deductibles and out-of-pocket expenses to lower the overall burden on the insured. One specific suggestion: shift premium tax credits from silver to gold plans. The latter tend to have overall lower costs to the consumer.