Expert Reflection

Easier Said Than Done

The author participated as a member of an expert panel convened to help decide affordability in health insurance—how much a person could be expected to pay, given different circumstances. The panel members read 61 vignettes that described income, age, number and age of family members, health status, and other factors.

Swartz found it difficult to judge a person’s ability to afford health insurance given bare bones details and found herself wanting missing details filled in. For example, was the man a single parent because his wife died? Was the woman with credit card debt a poor money manager or a person with high medical bills? Should child care expenses be subtracted from income when considering affordability of health insurance premiums?

While a percent-of-income rule is a practical way to determine affordability, the author acknowledged that higher income earners spend much less (by percentage) of their annual household income on employer-sponsored health insurance than do lower-income earners.

“Deciding what different people could be expected to pay for health insurance came down to worrying about how much of a difference in that percentage should be allowed—a quite subjective judgment,” she concludes.