The coronavirus pandemic is taking a heavy toll on millions of workers, especially those with moderate incomes. An estimated 14.6 million people lost health coverage through June. Millions more who still have employer benefits have lost wages and income, making their insurance costs an increased burden on household budgets. The Commonwealth Fund analyzed the extent to which workers in employer plans face high premium and deductible costs relative to their income. The burden of health-care costs for U.S. workers with job-based health insurance is determined by three factors -- median income, premium contributions and deductibles. This cost burden has increased over the past decade, because cumulative income growth over this period has trailed growth in premium contributions and deductibles. Related: Breakdown of a health insurance premium dollar in 2020 This study reached three general conclusions:

1. Premium contributions and deductibles were 10% or more of median income in 37 states in 2019, up from 10 states in 2010. Nine states have combined costs of 14% or more of median income.
2. The total cost of premiums and potential spending on deductibles across single and family policies ranged from a low of $5,535 in Hawaii to a high of more than $8,500 in nine states.
3. If premiums and deductibles do not fall this year, household income lost during the current economic crisis will increase cost burdens for middle-income families.

What impact will the coronavirus pandemic and the associated recession have on these variables? It is likely that the deep and prolonged recession will lower U.S. median income growth. Although the recession initially had the greatest impact on industries most affected by the pandemic, those effects now are spilling over into other sectors. This means that even if premium contributions and deductibles remain the same, they could take up a larger share of workers' incomes in 2020 and 2021. The pandemic's effects on premium contributions and deductibles is uncertain. Both variables are driven by trends in health-care costs. The past year has seen both spikes in health-care spending from COVID-19 hospitalizations and deep declines in spending from drops in elective surgery and other nonurgent care. The net effect appears to be overall lower spending and higher profits for insurance companies. In the employer market, even if premium contributions and deductibles fall, remain unchanged or grow more slowly, incomes could fall or grow more slowly, leaving household cost burdens unchanged or higher. Higher health insurance cost burdens will place some people in a precarious spot. People with low and moderate incomes may decide to go without insurance if it competes with other expenses. Uninsured or underinsured people may forgo getting tested for COVID-19, delay getting care if they become sick or delay getting vaccinated when a vaccine is available. The Affordable Care Act provides some cost protection to people with employer coverage in high-cost plans. First, people with low incomes (less than 138% of the federal poverty level) are eligible for Medicaid in the 38 states that have expanded eligibility. Second, people with employer premium expenses that exceed 9.83% of income are eligible for marketplace subsidies, which trigger a federal tax penalty for their employers. Read more: 

• Latest KFF report pegs employer-sponsored health insurance premiums at $21,342 per family
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• Stabilizing insurance premiums amid COVID-19 uncertainty