News Release

Income should be the dominant factor for reforming health care says the American public

Most Americans want lawmakers to provide extra funding for the sick and elderly

Peer-Reviewed Publication

Columbia University's Mailman School of Public Health

March 22, 2017 -- A new study on reforming U.S. healthcare showed that Americans believe a health insurance policy should be about 5% of household income to be affordable -- whether or not household income was low or high. They also feel that younger people--particularly singles--could pay somewhat more for health insurance and that healthier people could afford to pay more than those in poor health. Debt also played a role in decision-making for many respondents. These findings stand in stark contrast to the current health reform proposal forwarded by speaker Paul Ryan, which offers a fixed tax credit rather than one based upon household income.

Findings of the research conducted at Columbia University's Mailman School of Public Health, are published on SocArXiv, a website for the rapid dissemination of science. The researchers chose this format because legislation is moving too fast to publish in a traditional health policy journal.

Their findings were consistent whether a respondent lived in a red state or a blue state, suggesting that voters of all stripes feel that wealthier households can afford to pay a little more than lower-income households.

"Americans feel that everyone can afford to put about 5% of their household income toward health insurance and strongly favor a credit linked to the income that one makes," said Peter Muennig, MD, MPH, professor of Health Policy and Management at the Mailman School of Public Health. "They also do not favor placing extra burdens on the sick or elderly as the new Ryancare plan does."

The researchers created 61 vignettes to describe the living situations of various hypothetical households based on age, household income, marital status, presence of children, health conditions, the presence of debt or savings, and housing costs. Where children were present, the researchers specified that they would receive free coverage through the State Children's Health Insurance (SCHIP) program. Respondents were asked to assess how much each household could afford to pay per month using two different health insurance plans, one representing the typical high deductible policy and one the typical comprehensive policy.

While Congress is still debating how to repeal the ACA, the replacement plan currently under consideration--"Ryancare"--is an amalgamation and will transfer benefits from poorer households to wealthier households and from households in poor health to those in much better health, Dr. Muennig points out.

"Ryancare essentially takes from the poor, the sick, and the elderly and gives that money to the rich. People are not going to be happy with this plan," said Dr. Muennig. "Our findings were consistent whether the respondent lived in a red state or blue state. It made no difference."


The study was supported by the Robert Wood Johnson Foundation.

Columbia University's Mailman School of Public Health

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit

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