The nearly 180 million Americans with private health insurance coverage have experienced increased premiums and decreased benefits. However, little is known about how changes in privately insured families' contributions to insurance premiums and out-of-pocket spending have affected the financial burden of health care over the past two decades.

"This issue is particularly salient for those with low incomes, who are more susceptible to debt, bankruptcy and worse health outcomes due to poverty," according to a study reported in JAMA Internal Medicine. "Understanding changes in the financial burden of health care has important implications for patients and policymakers, who have made addressing care affordability a priority."

Researchers used Medicare Expenditure Panel Survey data from 2007 to 2019 for respondents and family members younger than 65 with private insurance. Families' total health care spending was calculated as contributions to premiums plus out-of-pocket medical and prescription drug spending. Families' annual financial medical burden was assessed by dividing total health care spending by post-subsistence income, which is income minus estimated food costs