1. State Trends in Costs of Employer Insurance Coverage: 2003 to 2013 Media Briefing January 7, 2015

2. Exhibit 2.Trends Highlights Marked slow-down in premium growth from 2010 to 2013 –31 States and D.C. lower annual increases in total premiums Yet, increases continue to outpace income in most states –Premiums notably high compared to income low-income states Deductibles and employee share of premiums up sharply since 2003 and continue to increase –Deductibles doubled or more since 2003 in all but 7 states –Only 3 states have average deductible under $1,000 –Out-of- pocket costs for premiums plus deductibles amount to higher share of median incomes all states compared to 2003 Trends underscore importance of focus on out of pocket costs and sustaining slow cost growth

3. Exhibit 3. Growth in Total Health Insurance Premiums for Employer Sponsored Plans, by State, 2003-10 & 2010-13 Notes: Growth rates for single person (employee only) plans. Average annual compound growth rate. Source: 2003, 2010, 2013 Medical Expenditure Panel Survey–Insurance Component. 32 states experienced slower growth from 2010 to 2013 compared to 2003 to 2010 2003-20102010-2013 < 4.0% 4.0% - 4.9% 5.0% - 5.9% 6.0% or more Average annual growth rate ND SD DC ID DE IA IN WI CA HI KS UT AZ NM AR LA KY VA VT NH MA CT RI NJ AK AL MS MI ME WV MD CO NE WY OR IL TN NC SC GA FL PA NY OH MO MN OK TX MT NV WA ND SD DC ID DE IA IN WI CA HI KS UT AZ NM AR LA KY VA VT NH MA CT RI NJ AK AL MS MI ME WV MD CO NE WY OR IL TN NC SC GA FL PA NY OH MO MN OK TX MT NV WA

4. Exhibit 4. Insurance Expensive No Matter Where you Live: Insurance Premiums for Family Coverage 2013 Source: 2013 Medical Expenditure Panel Survey–Insurance Component. U.S. average total family premium = $16,029

5. Exhibit 5. Total Premiums as Percent of Median Household Income for Under-65 Population, 2003 and 2013 Sources: 2003 and 2013 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 2013–14 Current Population Surveys (for median household incomes for under-65 population). 82 percent of under-65 population live where premiums amount to 20 percent or more of income ND SD DC ID DE IA IN WI CA HI KS UT AZ NM AR LA KY VA VT NH MA CT RI NJ AK AL MS MI ME WV MD CO NE WY OR IL TN NC SC GA FL PA NY OH MO MN OK TX MT NV WA ND SD DC ID DE IA IN WI CA HI KS UT AZ NM AR LA KY VA VT NH MA CT RI NJ AK AL MS MI ME WV MD CO NE WY OR IL TN NC SC GA FL PA NY OH MO MN OK TX MT NV WA Less than 14% 14%–16.9% 17%–19.9% 25% or more 20%–24.9%

6. Dollars per year for single coverage paid by employees Source: Medical Expenditure Panel Survey–Insurance Component (employee premium share for 2003 and 2013). Exhibit 6. Employee Premium Share Up: Annual Cost Nearly Doubled on Average from 2003 to 2013

7. 20032013 Percent change Percent with Deductible, all firms 52%81% State Range 16%-87%36%-98% Average, all firms Single-person plan $518$1,273146% State Range $356-$824$670-$1,784 Average, small firms Single-person plan $703$1,695141% State Range $258-$1,323$657-$2,755 Average, large firms Single-person plan $452$1,169159% State Range $303-$743$673-$1,595 Exhibit 7. Health Insurance Deductibles Spread and Doubled in Most States from 2003 to 2013 Note: Small firms = firms with fewer than 50 employees; large firms = firms with 50 or more employees. Source: Medical Expenditure Panel Survey–Insurance Component, 2003 and 2013.

8. Exhibit 8. Single-Person Deductibles, 2013 Deductibles Average $1,000 or More in All But 3 States Source: 2013 Medical Expenditure Panel Survey–Insurance Component. Dollars

9. Average Employee Share of Premium plus Average Deductible as Percent of Median State Incomes Source: Authors’ analysis Medical Expenditure Panel Survey–Insurance Component Compared to Median Income Census.. Exhibit 9. Employee and Family Out-of-Pocket Costs Up Compared to Incomes – Leaving Less for Other Needs

10. Exhibit 10. Conclusion and Implications Marked slow-down in premium growth from 2010 to 2013 compared to 2003-2010 in majority of states –Under 4% growth rates in almost all Southern states –National data indicates slow-growth continued in 2014 But employees and families see higher costs in most states –Out-of-pocket costs for employee share of premiums and deductibles continue to rise faster than income in all but a handful of states Lack of growth in income means health care costs squeeze family budgets, even at slower growth Findings indicate need for action to sustain slow- down without shifting costs to employees

11. Report and Data Sources C. Schoen, D. Radley and S.R. Collins, State Trends in The Cost of Employer Insurance Coverage 2003–2013, Commonwealth Fund Dec 18, 2014 Appendix tables provide details by state Data and Methods: Health insurance costs: analysis of Medical Expenditure Panel (MEPS) insurance panel; State averages 2003 through 2013 –Private employer based coverage –Includes total premium, employee share and deductibles State Median incomes: Census Current Population Survey –Two-year average for under-65 households –Single and family (2 or more people) households State average premium, employee premium and deductibles compared to incomes weighted by distribution of single and family households