Stethoscope and dollars Medicaidrecipients get the biggest dollar value in health care as apercentage of their income, while those with employer-sponsoredhealth insurance get the smallest dollar value. (Photo:Shutterstock)

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While higher-income Americans may pay the most in dollars towardthe nation's health care system, what they fork over pales incomparison as a share of income to what the nation's poor have tocough up.

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So says a new RAND Corporation study, which finds not only is thesystem regressive, but families in the highest-income group (out offive) pay 16 percent of their income toward health care whilehouseholds in the bottom fifth pay an average of 33.9 percent oftheir income toward health care.

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The middle three groups are on the hook for between 19.8 percentand 23.2 percent of their income. Health care spending itselfaccounted for nearly 18 percent of the U.S. gross domestic productin 2015, the year for which data was used from the Survey of Incomeand Program Participation, the Medical Expenditure Panel Survey,the Kaiser Family Foundation/Health Research Education TrustEmployer Health Benefits Survey, the American Community Survey andthe National Health Expenditure Accounts.

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Related: States coming up short on health careaffordability

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"Our findings suggest that health care payments in the UnitedStates are even more regressive than suggested by earlierresearch," says Katherine G. Carman, lead author of the study and asenior economist at RAND. "As national discussions continue abouthealth reform and health equity, it's important to understand howthe current health care system distributes costs and payments."

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Whether it's in obvious ways like paying premiums andout-of-pocket costs or "less-visible ways such as employer-paidpremiums and taxes," the report says, "ultimately all health carecosts are paid by households." But the lowest-income households inneed of long-term care are the ones bearing the highest cost, sincethey have to spend down assets in order to qualify for publicbenefits.

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Out-of-pocket spending, not counting insurance premiums, onlyamounts to 9.1 percent of health care costs. Most health care costsare met via health insurance premiums and taxes, with payments tofinance health care averaging out to $9,393 per person, or 18.7percent of average household income.

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Medicaid recipients get the biggest dollar value in health careas a percentage of their income, while those withemployer-sponsored health insurance get the smallest dollar value.The three lowest-income groups all receive more health careservices than they pay for through all forms of payments, the studyadds, while the fourth income group comes out more or less evenbetween payments and the dollar value of care received. Thehighest-income group actually pays much more into the system thanthey receive in health care services.

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