The U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation has published this issue brief about the financial condition and health care burdens of people in deep poverty.  Deep poverty is defined as having incomes below half of the federal poverty level.  For 2013, a single parent with two children would be in poverty at an annual income of $18,769 and in deep poverty at an annual income of $9,385. In 2013, over 45 million Americans were in poverty, and nearly 20 million were in deep poverty (6.3% of the total U.S. population).  Nearly one-third (6.5 million) of those in deep poverty were children under the age of 18.

For individuals and families in deep poverty, expenditures on basic necessities (food, housing, utilities, clothing) are higher than after-tax income, without considering costs for health care, transportation, child care, and education as part of basic necessities.

The key findings include:

  • Low-income individuals are especially sensitive to even nominal increases in medical out-of-pocket costs, and modest co-payments can have the effect of reducing access to necessary medical care.
  • Medical fees, premiums, and co-payments could contribute to the financial burden on poor adults who need to visit medical providers.
  • The problem is even more pronounced for families living in the deepest levels of poverty, who effectively have no money available to cover out-of-pocket medical expenses including co-payments for medical visits.

Even as health care insurance coverage continues to be expanded under the Affordable Care Act, ensuring the affordability of coverage and actual access to health care for millions of Americans in deep poverty will continue to be an ongoing challenge.

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