Despite the recession's effects on incomes and jobs, the share of people with high medical costs was mostly unchanged.

High medical cost burden is defined as spending more than 10 percent of family income on health care. Despite decreased family income and rising unemployment caused by the recession of 2007-09, the percentage of people under age sixty-five with high medical cost burdens remained largely unchanged between 2006 and 2009, at approximately 19 percent. That unexpected result, based on data from the Medical Expenditure Panel Surveys, contrasts with an increase from 14.4 percent to 19.2 percent in the share of people with high medical cost burdens between 2001 and 2006. The percentage did not change during the recent recession because decreased family income was offset by decreased out-of-pocket health spending. Virtually all of this decreased spending was because of lower spending on prescription drugs as people shifted from brand-name medications to less expensive generics.