31% of Californians who wanted care for urgent health issues during the pandemic did not receive it

Mental health has gotten “worse” or “a lot worse” for more than 1 in 3 respondents with low incomes

96% of Californians with low incomes report struggling with the stress of COVID-19

Substantial numbers of people of color say racial discrimination has impacted their mental health

Telehealth has become an essential source of care for Californians with low incomes — with 65% of low-income households who received care getting services by phone or video

Nearly one-third of Californians have delayed receiving care for urgent or emergency health issues during the COVID-19 pandemic, and 36% of those with low incomes say their mental health has gotten “worse” or “a lot worse,” according to a new survey conducted by the California Health Care Foundation and NORC at the University of Chicago. Meanwhile, 96% of Californians with low incomes report struggling with the stresses of COVID-19 — including access to food, rent, and childcare. Substantial numbers of people of color say their mental and physical health is worse as a result of the racial discrimination they have experienced throughout their lives.

With the COVID-19 pandemic dragging into its seventh month, the new CHCF survey polled 2,249 adults (age 18 to 64) at a range of income levels about their health concerns, experience, and access prior to and during the pandemic. With seven million Californians living in poverty — approximately 18% of the state’s residents — the survey quantifies the impact the pandemic is having on Californians with low incomes, who report nearly equal levels of worry about getting the coronavirus (41%) and suffering the pandemic’s economic impacts (37%). The poll was conducted between June 24 and August 21. The sample was disproportionately representative of Californians with low incomes, and respondents were limited to those who accessed care since March 2019.

“This has been a tumultuous year for all Californians, and we’re seeing some serious warning signs about the toll it may be taking on the public’s health,” says Carlina Hansen, senior program officer on CHCF’s Improving Access team, which oversaw development of the new survey.

“It is becoming increasingly clear how many vulnerable populations are delaying the health care they need — with consequences that should concern us all,” Hansen says. “Large numbers of Californians with low incomes especially are under serious stress, whether due to declining incomes or concern about their loved ones’ health. This is impacting everything from mental health to other health issues. Even in the midst of the pandemic, this survey highlights the next health crisis brewing among some of the state’s most vulnerable groups.”

Key findings from the survey include:

• Californians are delaying the health care they need. A large portion of survey respondents who wanted care since the start of the COVID-19 pandemic have not received it. Thirty-one percent of respondents who wanted to see a provider for urgent or emergency care for a health problem unrelated to COVID-19 did not receive care for that problem. A large majority (64%) plan to seek care in the next six months — including more than three in four respondents with Medi-Cal coverage (78%).
• Mental health is deteriorating, especially for Californians with low incomes. Over one-third of respondents (36%) reported that their mental health got “worse” or “a lot worse” since the start of the pandemic. More than two-thirds of respondents (68%) who wanted to see a provider for health care since the start of the pandemic sought care for a mental health problem.
• The pandemic has caused enormous stress to Californians, especially those with low incomes and Latinx Californians. Ninety-six percent of respondents with low incomes said they had experienced at least one COVID-19-related “stress,” ranging from the death of a loved one and marital challenges to affording basic needs such as food, rent, and childcare. Ninety-four percent of Latinx respondents reported experiencing at least one of these issues, compared to 91% of Asian, 89% of Black, and 84% of White respondents.
• Racial discrimination is directly impacting the health and well-being of people of color in California. Nearly 7 in 10 Black respondents (69%) reported personally experiencing discrimination or being treated unfairly because of their race or ethnicity. Thirty-one percent of people of color said their mental health was “worse” or “a lot worse” as a result of racial discrimination.
• Telehealth has become an essential source of care during the pandemic. Sixty-five percent of respondents with low incomes and 76% of respondents of color who accessed health care during the pandemic reported receiving a telehealth (phone or video) visit. Most Californians with low incomes reported positive experiences: 71% reported they would always like the option for phone or video visits, and 63% reported that they would likely choose a phone or video visit over an in-person visit whenever possible.

Read the full report Listening to Californians with Low Incomes: Health Care Access, Experiences, and Concerns Since the COVID-19 Pandemic.

About the California Health Care Foundation