The rising cost of health care continues to be one of California’s most urgent issues, according to a newly released statewide survey conducted by the California Health Care Foundation and NORC at the University of Chicago — with more than one in four Californians (27%) saying they or someone in their family struggled to pay at least one medical bill in the last 12 months, up from 20% two years ago. For Californians with lower incomes, the percentage increases to 44% reporting difficulty paying bills.

Nearly two-thirds (65%) of Californians report they are “very” or “somewhat worried” about unexpected medical bills and out-of-pocket health care costs. More than one in three Californians (36%) reports having some kind of medical debt — a figure that climbs to 52% for those with lower incomes. Of those with medical debt, one in five (19%) reports owing $5,000 or more.

Just over half of Californians (52%) report skipping or delaying at least one kind of health care due to cost in the past 12 months — and of those who delayed care, half (50%) say their condition got worse as a result.

“The high cost of care is now directly impacting the health and financial security of millions of California families,” says Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation. “Californians are also very concerned about a variety of other health issues — including homelessness and mental health, preparing public health departments for the next emergency, and ensuring every community has enough health care workers. But in poll after poll, what we see most consistently is that Californians want and need the rising cost of care to be contained.”

Californians are also concerned about having the financial resources to pay for any home-based support they or their family members will need as they get older with 44% of Californians reporting they are “not too” or “not at all” confident in having those resources. A new article on The CHCF Blog explores findings about home-based support in more detail.

The 2023 CHCF California Health Policy Survey was conducted from September 30, 2022, through November 1, 2022, among a random representative sample of 1,739 adults age 18 or older living in California. The annual poll captures Californians’ views on health care affordability, housing and homelessness, experiences with health care, COVID-19, and health equity.

More than half of Black Californians (55%) said there was a time in the last few years when they thought they would have gotten better care if they had belonged to a different racial or ethnic group, much higher than people who are Latino/x (27%), Asian (12%), and White (4%). While the total percentage of Californians who said that it was “extremely” or “very” important for the state to reduce racial and ethnic inequalities in health care is essentially the same as last year (66% compared to 65%), the percentage of those saying it was extremely important grew from 33% last year to 38% this year, a statistically significant change.

“The data are clear that Black Californians face very real barriers to health care because of their race,” said Stremikis. “A strong majority of Californians see this unequal treatment as a serious problem and want their leaders to make the system more fair and just.”

In addition, the poll finds that the vast majority of Californians share the following top health policy priorities:

• Mental health: Making sure people with mental health issues can get the treatment they need (83% say “very” or “somewhat” important).
• Public health: Making sure state/county/public health departments have the resources they need to respond to emergencies (85% say “very” or “somewhat” important).
• Health workforce: Making sure there are enough doctors, nurses, and other health care providers across California (85% say “very” or “somewhat” important).
• Health care affordability: Lowering the amount people pay for health care (79% say “very” or “somewhat” important).
• Reproductive health care access: Making sure people have access to reproductive health care including abortion (66% say “very” or “somewhat” important).

This year’s poll includes several other noteworthy changes from past surveys, including new trends in Californians’ use of mental health care (up from 30% last year to 33% this year) and growing concerns about caring for an aging population (44% of respondents say they lack confidence in their ability to pay for home-based support). Some of the biggest shifts from last year’s poll were on the following topics:

• COVID-19: After dominating Californians’ lives for the last three years, the pandemic has begun to fade as a top health priority. The largest year-over-year difference in CHCF polling was on the issue of addressing COVID-19: Last year, 46% of Californians saw it as an “extremely” important issue for the governor and legislature to address. This year, 25% say the same.
• Health care and housing: The poll finds widespread acknowledgment that a lack of affordable housing impacts health outcomes. About half of Californians (47%) agree with the statement “housing has a big impact on health, and doctors should refer patients to programs that can help” — a figure that climbs to 53% for lower-income households. The poll finds the percentage of Californians who say making housing more affordable is “extremely” important jumped to 57% from 49% in last year’s poll.

About the California Health Care Foundation