Cathy Schoen Senior Vice President The Commonwealth Fund commonwealthfund cs@cmwf

1. State Trends in Premiums and Deductibles, 2003–2009: How Building on the Affordable Care Act Will HelpStem the Tide of Rising Costs and Eroding Benefits Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org December 1, 2010

2. Figure 1. Premiums for Family Coverage, by State, 2009 Dollars U.S. average = $13,027 Data source: 2009 Medical Expenditure Panel Survey–Insurance Component.

3. 2003 2009 NH ME WA NH VT ME WA VT ND MT ND MT MN MN OR NY MA WI OR MA NY ID SD WI RI MI ID SD RI WY MI CT PA WY NJ CT IA PA NJ NE IA OH DE IN NE OH NV DE IN IL MD NV WV UT VA IL MD CO DC WV UT VA KS MO KY CA CO DC KS MO KY CA NC NC TN TN OK SC AR OK AZ NM SC AR AZ NM MS GA AL MS GA AL TX LA TX LA FL FL AK AK 18% or more HI HI 16%–17.9% 14%–15.9% Less than 14% Figure 2. Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and 2009 Data sources: 2003 and 2009 Medical Expenditure Panel Survey–Insurance Component (for total average premiums for employer-based health insurance plans, weighted by single and family household distribution); 2003–04 and 2009–2010 Current Population Surveys (for median household incomes for under-65 population).

4. Figure 3: Private Health Insurance Deductibles: State Averages by Firm Size and Household Type, 2003-2009 Single Person Plan Family Plan Data source: Medical Expenditure Panel Survey–Insurance Component, 2003 and 2009. Small is less than 50 employees.

5. Figure 4. Premiums for Family Coverage, 2003, 2009, 2015, and 2020 Health insurance premiums for family coverage Data sources: Medical Expenditure Panel Survey–Insurance Component (premiums for 2003 and 2009); Premium estimates for 2015 and 2020 using 2003-09 historic average national growth rate.

6. Figure 5. Projected Annual Savings in Family Premiums, 2015 and 2020 Data sources: 2009 Medical Expenditure Panel Survey–Insurance Component; Premium estimates for 2015 and 2020 using 2003–09 historic average national growth rate.

7. Summary and Implications • Past two decade trends spell higher premiums and worse coverage • Premiums up and buying less protective benefits • Squeeze on businesses and families across the country • Health and Economic security at risk • Uninsured and under-insured • Affordable Care Act Potential for New Directions • Benefit standards with financial protection • Premium help for lower and middle class families • Premium oversight and exchanges to curb excessive increases • System reforms to slow cost growth and improve access, quality and safety