Louisiana families are facing the highest health insurance cost burden in the nation, with middle-income households spending 15.6% of their income on employer-sponsored health coverage, according to a new analysis from the Commonwealth Fund.
The report, released February 11, 2026, found that in 2024, premium contributions and deductibles for family plans consumed 10% or more of the median household income in 19 states. Louisiana topped the list, significantly exceeding the federal affordability standard of 8.4% for employer-sponsored health plans. Florida, Mississippi, and North Carolina followed closely behind, all at 13.7%.
The Commonwealth Fund analysis examined costs for family coverage, excluding copayments. The median household income in the United States in 2024 was $83,730, but in Louisiana, the financial strain is particularly acute due to comparatively lower wages. “Southern workers face some of the highest cost burdens since wages in the region are lower, so families spend a bigger share of their pay on employer coverage,” explained Kristen Kolb, a research associate at the Commonwealth Fund, in a statement to Stateline.
Nationally, approximately 167 million working-age adults under 65 receive health insurance through their employer or a family member’s plan. While employers typically cover around 70% of family coverage premiums, employees are responsible for the remaining portion, as well as deductibles and copays. In 2024, employees contributed an average of $7,216 annually towards family coverage, part of an average total cost of $24,540.
The financial pressure extends to single coverage as well. In 26 states, deductibles represented 5% or more of the median individual income in 2024, with the Southeast and Midwest experiencing the most significant impact.
The rising cost of healthcare is a continuing trend. Costs increased by 6% in 2025 compared to 2024, and further increases are anticipated. Sara Collins, a senior scholar for health care coverage and access at the Commonwealth Fund, stated that “Premiums and deductibles for many American workers can drain household budgets and increase the risk that people will delay care or accept on medical debt.”
Adding to the financial challenges, enhanced tax credits available through the Affordable Care Act marketplaces expired at the end of last year, reducing financial assistance for some individuals and families purchasing insurance through those exchanges.
Collins emphasized the demand for collective action, stating, “Congress, employers, insurers and health care providers all can play a role in lowering costs and making care more affordable, so families across the income spectrum can gain the care they need.”
