Income gaps

Is the longevity gap widening, and who is gaining years while the bottom stays stuck?

The richest 1% of American men live 14.6 years longer than the poorest 1%, and the richest 1% of women 10.1 years longer than the poorest. Below the poverty line, one in five people delayed or went without needed medical care because of cost.

Question

The problem

Income operates like a hidden triage system across the U.S. care landscape: it affects insurance stability, ability to absorb premiums and out-of-pocket costs, timing of care, and ultimately life expectancy. The hospital and payer system can deliver medical advances nationally while lower-income households fail to receive the same longevity gains.

The recommendation

Treat affordability as a health-outcomes intervention. The recommended approach is to reduce cost barriers at the point of care, protect lower-income households from premium and deductible pressure, and evaluate progress by whether lifespan and delayed-care gaps narrow for the bottom of the income distribution.

The lifespan gap

How many years of life income buys, and whether the gap is actively widening. The poorest gained almost no life expectancy from 2001 to 2014.

14.6 yrs

how much longer the richest 1% of men live than the poorest 1%

for women the gap is 10.1 years, based on 2001 to 2014 records

+2.34 yrs

life expectancy the top 5% of men gained from 2001 to 2014

the bottom 5% of men gained just 0.32 years, about 7 times less

Expected age at death at 40 rises with every rung of the income ladder

Each line runs across all 100 income percentiles, from poorest at left to richest at right. The table shows every fifth percentile.

Read it this way Both lines climb steadily from the poorest to the richest percentile, showing that expected age at death rises with every step up the income ladder rather than jumping only at the extremes. The relationship is observational: the data traces a strong association between income rank and lifespan but does not establish that income itself causes the difference. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

Caveat Values are race-adjusted expected age at death for people who have already reached age 40, pooled over 2001 to 2014, not life expectancy from birth. The relationship is observational, not proof that income itself causes the gap.

⊞ data table⬇ CSV

Income percentile	Men (age at death)	Women (age at death)
1	72.74	78.78
5	76.03	81.63
10	76.39	81.75
20	77.7	82.93
30	79.18	83.83
40	80.73	84.45
50	81.69	85.02
60	82.57	85.55
70	83.37	86.08
80	84.18	86.69
90	85.41	87.46
95	86.15	88.3
99	86.91	88.61
100	87.34	88.87

Health Inequality Project (Chetty et al., JAMA) · 2001 to 2014 · source

The top gained years, the bottom gained almost none, 2001 to 2014

Years of life expectancy at 40 gained over the period. The top 5% pulled away while the bottom 5% barely moved.

Read it this way The bars compare years of life expectancy gained over the same 13-year period: the top 5% of men and women gained 2.34 and 2.91 years, while the bottom 5% gained only 0.32 and 0.04. It is the gap in gains, not just the gap in starting levels, that this chart isolates. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

⊞ data table⬇ CSV

Income group	Sex	Years gained 2001 to 2014
Top 5% by income	Men	2.34
Top 5% by income	Women	2.91
Bottom 5% by income	Men	0.32
Bottom 5% by income	Women	0.04

Health Inequality Project (Chetty et al., JAMA) · 2001 to 2014 · source

The cost barrier

How income gates whether a family can afford care, what they pay out of pocket, and how fast the premium burden is rising for a working family.

the poorest delay needed care about four times as often as the top income group

20.4% below poverty vs 5.0% at 400% of poverty or more, 2019

$6,492

average worker share of a family health premium, 2022

out of a $21,931 total family premium, private-sector employers

Both cost barriers fall as income rises

Two barriers by family income as a share of the federal poverty level. Each series carries its own year because the two measures come from different surveys.

Read it this way Both bars in each income group fall as income rises, showing the same downward pattern across two different cost-barrier measures. Because the two series are dated 2019 and 2023, compare the direction of the pattern across income bands rather than treating the two bars as one unified statistic. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

Caveat Delayed care is 2019 and the uninsured rate is 2023 because CDC has not re-published the delayed-care-by-poverty breakdown since 2019. Each series is dated in the legend rather than presented under one shared year.

⊞ data table⬇ CSV

Income band	Delayed care 2019 (%)	Uninsured 2023 (%)
Below 100% FPL	20.4	15.1
100 to 199% FPL	20.2	14.7
200 to 399% FPL	13.5	9.3
400% FPL or more	5	3.6

CDC NCHS, Health, United States (delayed care) and NHIS Early Release (uninsured) · 2019 and 2023 · source

Median family out-of-pocket health spending by income, 2015

Median out-of-pocket spending for non-elderly families, excluding insurance premiums. Latest year AHRQ MEPS published this income-stratified breakdown.

Read it this way Dollar spending rises with income, from 86 dollars for poor families up to 868 for high-income families. Because this is absolute spending and not a share of income, a taller bar here does not mean a heavier financial burden, as the caveat explains. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

Caveat Higher-income families spend more out of pocket in absolute dollars because they use more care and face fewer coverage subsidies, so a larger dollar figure here is not a larger burden as a share of income.

⊞ data table⬇ CSV

Income group	Median out-of-pocket ($)
High income	868
Middle income	504
All non-elderly families	451
Low income	252
Poor	86

AHRQ MEPS Statistical Brief #507 · 2015 · source

Worker premium contributions rose from 2019 to 2022, with family coverage rising fastest

Average annual employee premium contribution at private-sector employers, by coverage tier. Family coverage rose fastest.

Read it this way All three tiers end higher in 2022 than in 2019 (single coverage dipped slightly in the final year), and the family-coverage line climbs from 5,726 to 6,492 dollars, the steepest increase of the three tiers shown. The chart shows the pace of increase for each coverage tier, not what share of a household's income that contribution represents. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

⊞ data table⬇ CSV

Year	Single ($)	Employee + one ($)	Family ($)
2019	1489	3881	5726
2020	1532	4035	5978
2021	1643	4199	6174
2022	1637	4237	6492

AHRQ MEPS Insurance Component, Statistical Brief #553 · 2019 to 2022 · source

Who pays the family premium, worker vs employer, 2019 to 2022

Each bar places the worker contribution at the bottom and the employer contribution on top; the full bar height is the total family premium.

Read it this way The worker's share sits at the bottom of each stacked bar and the employer's share on top, so the full bar height is the total family premium, which rose from 20,486 to 21,931 dollars over the period. The employer segment is computed as the total minus the worker contribution rather than reported directly. Use this chart to connect income-related health differences to an actionable affordability lever, then assess whether the recommendation is aimed at access, premiums, out-of-pocket burden, or long-run longevity.

Caveat The employer share is computed as the total family premium minus the worker contribution. Figures cover private-sector establishments only.

⊞ data table⬇ CSV

Year	Worker share ($)	Employer share ($)	Total family premium ($)
2019	5726	14760	20486
2020	5978	14780	20758
2021	6174	15207	21381
2022	6492	15439	21931

AHRQ MEPS Insurance Component, Statistical Brief #553 · 2019 to 2022 · source

Geography

The same question, state by state and then county by county. Pick a state in the filter above to drill into its counties.

Population below poverty

County · direct count

Each tile is a state. Pick a state in the Scope control above to drill into its counties.

CDC/ATSDR Social Vulnerability Index · 2022 · source

Uninsured rate (all ages)

County · direct count

Each tile is a state. Pick a state in the Scope control above to drill into its counties.

Census SAHIE / ACS via HealthPulse · 2022 · source

Why this matters

The life-expectancy gap did not hold steady over the study period, it widened, with the top 5% gaining roughly seven times the years of life expectancy that the bottom 5% gained. At the same time, premium costs rose for every income band. Leadership should care because the trend is diverging, not stable, and the group gaining the least in life expectancy is also carrying growing cost exposure.

Recommended actions

Target cost-sharing relief and subsidy expansion at income bands below 200% FPL, where delayed or forgone care runs near 20%, roughly four times the rate above 400% FPL.
Treat 100-199% FPL as part of the same low-income plateau as below-100% FPL, since their delayed-care rates (20.2% vs 20.4%) sit almost level rather than showing a cliff only at the poverty line.
Monitor the pace of family-premium worker contributions (up from $5,726 to $6,492, 2019 to 2022) as a leading indicator of affordability strain on lower earners.
Track life-expectancy gains by income percentile in future years to see whether the 2001-2014 divergence, the top gaining about seven times faster, persists or narrows.
Push for income-stratified out-of-pocket burden reporting as a share of income, not just dollars; the most recent published breakdown (2015) only shows absolute spending, which understates burden at the bottom.

The recommendation

Therefore, treat affordability as a health-outcomes intervention. The recommended approach is to reduce cost barriers at the point of care, protect lower-income households from premium and deductible pressure, and evaluate progress by whether lifespan and delayed-care gaps narrow for the bottom of the income distribution.

Demographic slice income. Chetty income-percentile data + ACA-subsidy-bracket data.

Sources