Over the last several years, Californians have come together to provide health insurance coverage to more than 1 million additional residents, increase access to social services that improve health and well-being, and continue efforts to reduce unequal patient treatment and outcomes in our health care system. But as we continue to work our way out of the COVID-19 pandemic, there remains no shortage of health care challenges facing our state, including rising health care costs, strains on our mental health system, persistent provider shortages, and increasing wait times for care in many communities, according to the 2024 CHCF California Health Policy Survey.

The poll offers a comprehensive look at the health issues Californians are most worried about — and what they hope state policymakers will prioritize in the coming year. The poll was conducted last fall by CHCF and NORC at the University of Chicago.

CHCF has been publishing its policy survey annually for five years. In doing so, it has identified shifting trends in the health care landscape, as well as emerging issues like the impacts of climate change on health and Californians’ views about the use of artificial intelligence in health care. The complete findings can be found here.

Key Takeaways from the Poll

While the survey includes many new and interesting insights about the health care experiences and policy priorities Californians share, my top five takeaways from this year’s research are:

1. California’s mental health system is strained. This year’s CHCF poll finds more than half (52%) of those who tried to make a mental health care appointment in the last year had trouble finding a mental health provider who would accept their insurance. And a similar proportion (55%) reports unreasonable wait times for mental health treatment. When asked about treatment for serious mental illness, more than two in three Californians (67%) believe improvement is needed. Increasing access to mental health treatment is now an “extremely” or “very” important health policy priority for four in five Californians (81%).
2. Health care costs and medical debt are making Californians sicker. More than half of Californians (53%) say they skipped or postponed care due to cost in the last year — a number that rises to a startling three of four when it comes to Californians with low incomes (74%). This is leading to greater health challenges, as more than half of those who skipped care (54%) say their condition got worse as a result. Meanwhile, close to 4 in 10 Californians (38%), and over half of those with low incomes (52%), say they are carrying medical debt, with nearly one in five owing $5,000 or more.
3. Significant work remains to improve racial equity in health care. Despite renewed efforts to acknowledge and respond to racial inequities in the health system, Californians have mixed views on the pace of improvement. While 42% of Californians overall believe the state has made “a great deal” or “some” progress toward racial and ethnic health equity in the last several years, 44% of Black Californians and 33% of Latino/x Californians say the state has made “only a little progress” or “no progress at all.” Nearly half of Californians (45%) say the health system “regularly” or “occasionally” treats people unfairly because of their race — a number that climbs to 67% for Black Californians. A recent CHCF study, Listening to Black Californians, identified a range of policy actions and practice changes at the clinical, administrative, and training levels that could reduce the impact of racism on Black Californians’ health care experiences and improve their health outcomes.
4. California’s health workforce shortage continues to affect many communities. Nearly half of Californians (46%) think their community does not have enough mental health care providers, including psychologists and therapists, to meet the needs of residents. And 42% say their community does not have enough nurses or primary care providers. These numbers have climbed since 2022 for many health professions. Multiracial (69%) and Black Californians (56%) are more likely than Asian (37%) and White Californians (45%) to say their community lacks sufficient mental health providers.
5. Extreme weather is a growing health issue in the Golden State. With the impacts of climate change becoming part of everyday life, more than half of Californians (53%) say they are “very” or “somewhat” worried about the effects of environmental factors such as extreme heat, floods, wildfires, and poor air quality on the physical or mental health of someone in their family. That number climbs to 65% for people with low incomes. Among Californians who speak Spanish, 82% say they are “very” or “somewhat” worried about the effects of weather on their health compared with those who speak English (52%) or Chinese (51%). One in five Californians (21%) — and 29% of state residents with low incomes — report that extreme weather has had an impact on their health.

The full health policy poll report has much more detail on these and many other health-related issues concerning Californians, including housing and homelessness, as well as challenges with navigating the health system.

Kristof Stremikis

Kristof Stremikis is director of CHCF’s Market Analysis and Insight team, which promotes greater transparency and accountability in California’s health care system. Read More

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