Low-income workers and those in rural areas more likely to be cost burdened

WASHINGTON, DC – New research shows that a typical working family in the US is paying nearly $4,000 in out of pocket medical costs – a number that is likely a conservative estimate, and will be substantially higher due to the recent expiration of Affordable Care Act subsidies.

The new findings come from “The High Cost of Living: What Working Families Pay For Health Care,” a new report for the Center for Economic and Policy Research (CEPR). Using Census Bureau data covering the 2024 calendar year, authors Emma Curchin and John Schmitt find that the median working family (with at least one worker between the ages of 18 and 64) spent $3,960 per year on health care – a figure that would include their share of insurance premiums plus any additional out-of-pocket expenses.

These dollar figures come into focus when examining the share of families that are cost burdened – meaning they spend ten percent or more of their income on health care. Roughly one in eight working families (13.3 percent) reached that threshold in 2024. For working families in the bottom quintile of family income, 22.1 percent are health care cost burdened – roughly double the 11.2 percent rate for upper-middle-income households and five times the 4.0 percent rate for the best-off fifth of working families. An estimated 16.9 percent of families in the second income quintile and 17.0 percent of those in the middle income quintile paid ten percent or more of their income on health care.

And nearly one in five (18.8 percent) working families in rural areas were cost burdened, a finding that is likely due to lower incomes for workers in those parts of the country. 

The new CEPR report uses data from the Annual Social and Economic Supplement (ASEC) of the Census Bureau’s Current Population Survey (CPS). The analysis is drawn from the most recent available year of ASEC data, released to the public in September 2025 and covering the full calendar year 2024. Health care expenditures are measured by the sum of each family’s total outlay for health insurance premiums (excluding any employer contribution) and any additional out-of-pocket expenses not covered by the family’s insurance – which may include co-pays, deductibles, co-insurance, uncovered services, denied claims, and other direct payments to providers.

The data analyzed likely underestimate the true extent of health care cost burdens. A recent longitudinal study published in JAMA Internal Medicine, which followed the same individuals over a four-year period, found that almost three times more individuals experienced health care burdens at some point if the window of analysis was expanded from one year to four years.

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