Publication Date


Document Type

Book Chapter

Organizational Units

Sturm College of Law


Essential health benefits, Affordable Care Act, Financial risk protection, Out-of-pocket costs, Impoverishment, Catastrophe, Universal health coverage


This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care.

Publication Statement

Originally published as Govind Persad & Harald Schmidt, Sufficiency, Comprehensiveness of Healthcare Coverage and Cost-Sharing Arrangments in the Realpolitik of Health Policy, in What is Enough?: Sufficiency, Justice, and Health 267-281 (Carina Fourie & Annette Rid, eds., 2016). Reproduced by permission of Oxford University Press.

Copyright is held by the authors. User is responsible for all copyright compliance.

Rights Holder

Govind Persad, Harald Schmidt


Received from author

File Format



English (eng)


15 pgs

File Size

484 KB

Publication Title

Oxford University Press

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