Employer-sponsored health insurance premiums grew more slowly in 31 states and the District of Columbia between 2010 and 2013, following passage of the Affordable Care Act. But because wages have grown even more slowly over this period, average annual premiums — including both the employer and employee contributions — by 2013 represented 20% or more of household income in 37 states, compared to just two states in 2003.

That is the conclusion of a new Commonwealth Fund report that analyzes trends in premium and deductible growth state-by-state over a 10-year period. A companion analysis to an earlier Commonwealth Fund report on national premium trends, the new report finds that in every state, health insurance costs grew faster than income. Workers in Southern states, where median incomes are lower than elsewhere in the U.S., face the highest cost burdens.

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