In December 2015, a study was published unveiling the harsh truth of the marketplace: high deductibles and out-of-pocket costs are very much present in the Affordable Care Act, and some marketplace customers will spend up to 25% of their income on healthcare expenses this year. According to this research, even after taking into account the subsidies offered to make healthcare more affordable, people who purchase health insurance through the marketplace can expect to spend more than 10% of their annual income between premiums owed, deductibles, and other out-of-pocket payments included in their health plans.

The study, which used a model to estimate household spending on health insurance expenses by individuals and families at different income levels, went so far as to incorporate the tax credits available to people who produce an income that is between 100% and 400% of the federal poverty level ($11,770 to $47,080 for individuals). Moreover, it included cost-sharing reductions that may lower out-of-pocket expenses for people who generate incomes of up to 250% above the federal poverty line ($29,425 for an individual) if they purchase silver plans.

Even after analyzing individuals and families who qualified for these tax credits and/or cost-sharing reductions, the study showed that people with modest incomes and average medical expenses are burdened with high healthcare financial costs. Moreover, the study concluded that for people with significant medical needs the financial can be even heavier, estimating payments of at least 21% of people’s incomes on premiums and out-of-pocket costs. Sadly, the study revealed that the ones that get hit the hardest are elderly people. Between higher premiums based on age and higher out-of-pocket healthcare costs, customers between the ages of 55 and 64 can expect to pay as much as 24.5% of their income on healthcare expenses, putting them in the top 10% of the study based on spending amounts.

Clearly, policymaker need to address these healthcare reform issues. Not doing so could result in discouraging a great amount of people from purchasing such a valuable necessity as healthcare is. One of the solutions proposed by John Holahan, co-author of the study and a fellow at the Urban Institute’s Health Policy Center is to bind premium tax credits to gold plans as opposed to silver plans, because gold plans provide a more generous coverage and include lower deductibles. Another suggestions researchers made was to improve the cost-sharing reduction options currently available for lower income customers. The down side about both of these suggestions is that they would mean more government spending, which may be hard to get an approval for. Either way, something must give because at the rate things are going according to this study, the marketplace is not really offering affordable healthcare for its people.