Families earning the median household income chuck 10% or more of their paychecks toward employer-sponsored health coverage in 19 states — especially in the southern US.

That share may rise if incomes can’t keep up with rising healthcare costs, according to an analysis of 2024 data from the Commonwealth Fund.

“Each year, when those insurance premiums renew, there’s a good chance that insurance premium went up more than that person’s sort of annual raise, annual merit increase,” David Radley, senior scientist for the Commonwealth Fund, told Yahoo Finance. “It actually feels like it’s eating up a larger portion of their paycheck.”

Most Americans under 65 get their health coverage from their workplace or a family member’s employer, with companies typically footing about 70% of premiums for a family plan and workers paying the rest, plus deductibles. In their analysis, the Commonwealth Fund researchers sought to understand what a typical middle-class family pays out of pocket, state by state.

They found that, combined, premiums and deductibles on family plans averaged 10.1% of the median family’s household income nationwide. Costs just for family coverage premiums averaged $24,540, while families contributed $7,216.

Families in some states had it harder, with combined premium and deductible costs eating up 15.6% of incomes for family coverage in Louisiana and 13.7% in Florida, Mississippi, and North Carolina.

“In the Southeast, where incomes just on average are lower, those health insurance costs make up a much larger share of that sort of average worker’s family income,” Radley said.

In New Hampshire, meanwhile, the cost of premiums and deductibles totaled 6.9% of median household income in 2024. In Washington, D.C, the share was 5.7%.

Of course, that data is a few years old. Last year, a survey from the health policy nonprofit KFF found annual premiums for employer-sponsored family plans reached an average of nearly $27,000, with workers paying $6,850. Employers expected costs to shoot up further in 2026 amid higher healthcare utilization rates, as well as the proliferation of weight-loss drugs and higher-cost therapies, among other factors.

“Even for people who have coverage — reasonable coverage from their employers — the affordability of that coverage is a real problem, it’s a real concern for a lot of families,” Radley said. “People are spending more money for plans that give them less protection.”

Emma Ockerman is a reporter covering the economy and labor for Yahoo Finance. You can reach her at emma.ockerman@yahooinc.com.