More Americans will likely assume greater responsibility for the cost of their health care in the future, potentially sparking a crisis in the middle class as families and singles are forced to make tradeoffs between medical care and other financial commitments, a new analysis by Booz Allen concludes.

Up to 60% of the privately insured in the U.S. – roughly 120 million people – will be enrolled in a high-cost health plan by 2020. Many patients today are being forced to spend a greater percentage of their income on health care, with about 38 million Americans (more than 20% of privately insured people) facing out-of-pocket expenses that account for more than 10% of their after-tax income.

Additionally, more than 15% of privately insured Americans are already enrolled in a high-deductible health plan. Enrollment in consumer-driven health plans is estimated at 5% to 6% of the market in 2007. Meanwhile, 10% of people enrolled in traditional health plans faced deductibles exceeding $1,000 in 2007, up from only 4% in 2002, Booz Allen finds.

By 2020, Booz Allen predicts that enrollment in conventional health plans with high-cost features could reach 35% to 40% of the privately insured market, while enrollment in consumer-driven health plans could reach 20% to 25%.

Mandatory coverage requirements may force more employers to adopt high-cost plans, which may not improve access to care, Booz Allen reports. Moreover, states that mandate universal health insurance may ultimately have little impact, as the out-of-pocket costs could prove too high a threshold for many workers.

"Giving consumers more cost responsibility in a broken wholesale health care market will not work," says Gary Ahlquist, Booz Allen senior vice president. "The supply side of health care needs to be restructured such that patients can shop by comparing value."