The highest-income Americans saw healthcare spending grow while spending among the lowest-income group remained flat from 2005 to 2023, according to a study published in the July 2026 issue of Health Affairs.
Researchers from the University of Chicago and the American Board of Internal Medicine analyzed spending data from the Medical Expenditure Panel Survey, an annual HHS survey of the civilian U.S. population.
Here are five things to know:
1. Age- and health-adjusted spending grew 1.8% annually among the highest-income 20% of Americans from 2005 to 2023, compared with no growth among the lowest-income 20%.
2. The adjusted per capita spending gap between the highest and lowest income quintiles exceeded $4,700 in 2023. If recent trends continue, the authors project that gap will keep widening.
3. The ACA’s insurance expansions coincided with a temporary narrowing of the gap. From 2013 to 2017, spending among the lowest-income quintile grew 4.4% annually, outpacing the highest earners’ 0.7%. From 2018 to 2023, the pattern reversed: top earners saw 2.5% annual growth while the lowest-income quintile declined 2.5%.
4. Prescription drug spending showed the sharpest recent divergence — up 4.2% annually for the highest earners from 2018 to 2023, while falling 7.4% annually for the lowest-income quintile. Outpatient spending followed a similar pattern.
5. The authors note that both prescription drugs and outpatient services tend to be more discretionary than inpatient or emergency care, raising the possibility that lower-income Americans may be forgoing or delaying care as costs outpace their incomes.
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