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Growing Numbers of Californians Are Having Problems Paying Medical Bills — and Half Say They Have Skipped or Postponed Health Care in the Last Year Due to Cost

The rising cost of health care continues to be one of California’s most urgent issues, with one in four Californians saying they have struggled to pay at least one medical bill in the past 12 months — up from 20% last year — and 49% saying they have postponed care due to cost, according to a newly released statewide survey conducted by the California Health Care Foundation and NORC at the University of Chicago. Of those who postponed care, the survey finds, 47% report their health condition worsened as a result, up from 41% last year.

More than 8 in 10 Californians say it is “extremely” or “very” important for the California governor and legislature to work on “making health care more affordable” in the coming year — a level of support higher than several other noteworthy issues, from improving public education and combating climate change to addressing racial inequality.

The 2022 CHCF California Health Policy Survey was conducted September 27 through November 17, 2021, among a random representative sample of 1,681 adults age 18 and older living in California. The annual poll captures Californians’ views on health care affordability, housing and homelessness, experiences with health care, health care equity, and COVID-19.

Although it was conducted before the Omicron surge, this year’s survey finds COVID-19 continues to be a major concern for Californians, with 56% saying their health has been negatively impacted by the stress and anxiety caused by the pandemic. One in 10 Californians says the pandemic has worsened their chronic health conditions.

Topping the list of Californians’ health care priorities is making sure state and county public health departments have the resources they need to respond to emergencies (51% said this was “extremely” important, 34% said “very” important). This was followed by ensuring there are enough doctors, nurses, and other health providers across California (48% “extremely,” 39% “very”), providing all Californians with access to health insurance coverage (48% “extremely,” 32% “very”), and making sure people with mental health problems get the treatment they need (47% “extremely,” 36% “very”).

“The latest numbers show that the high cost of health care and the high cost of housing are both taking a toll on the health of Californians,” says Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation. “The rising cost of medical care is causing millions of Californians — especially people with lower incomes and communities of color — to postpone care and experience worse health outcomes as a result. Californians are clear they want this problem to be addressed.”

Other key findings from this year’s survey include these:

·    While cost issues are a rising concern for all Californians, they have become particularly serious for lower-income households: 43% of Californians with lower incomes report having problems paying for at least one medical bill, an increase from 32% compared to last year. More than 6 in 10 Californians overall worry about unexpected medical bills (63%) and out-of-pocket health care costs (60%), and half of Californians are worried about affording monthly health insurance premiums (51%) and prescription drugs (49%). By comparison, 52% of Californians said they were worried about gas costs, and 50% worry about the cost of their rent or mortgage.

·     Nearly one in five Californians (17%) who report trying to make an appointment for physical health care say it was “very” or “somewhat” difficult to find a provider who took their insurance. Latinx Californians (21%) are twice as likely as White Californians (11%) to report difficulty, and those with lower incomes (30%) are more likely than those with higher incomes (12%) to report that it was difficult to find a physical health care provider who took their insurance.

·     One in five Californians (19%) say they or someone close to them has experienced a period of homelessness in the past five years. The same proportion (19%) are “very” or “somewhat” worried about experiencing homelessness. Californians also see a connection between affordable housing and health status, with 80% of Californians saying lack of affordable housing impacts the physical or mental health of people with low incomes “a lot” or “some.”

·     Nearly 6 in 10 Californians (59%) believe that the health care system treats people unfairly based on their race or ethnic background: one quarter (26%) “regularly” and a third (33%) “occasionally.” Eighty-three percent of Black Californians expressed this belief, a significantly higher percentage than any other race or ethnic group. In addition, Black and Latinx Californians were more likely than White or Asian Californians to report negative experiences by a doctor or other health care provider.

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