Despite its large economy, California is also the state with the highest poverty rate (19%) according to the US Census Bureau (PDF). In late 2018, the Kaiser Family Foundation (KFF) and the California Health Care Foundation conducted a representative survey of the state’s residents to gauge their views on health policy priorities and their experiences in California’s health care system. This summary examines key findings from the survey among Californians with low incomes, defined here as those whose self-reported incomes are below 200% of the federal poverty level (approximately $49,000 for a family of four). Where relevant, they are compared to Californians with higher incomes — those with self-reported incomes at or above 200% of the federal poverty level.

Overall, the survey finds that while Californians at all income levels see health care as an important priority for the governor and legislative leaders to work on, health care affordability and access emerge as particularly prominent concerns among state residents with low incomes. Key findings include:

• Affordability of health care has affected treatment decisions for many Californians with low incomes, with over half saying that in the past year, they or someone in their family has delayed or forgone some type of medical or dental treatment due to costs.
• Californians with low incomes are almost twice as likely as residents with higher incomes to say they have had problems paying medical bills. As a result, many of those who experienced difficulty paying medical bills say they have had to cut back spending in other areas, use savings, or borrow money.
• Californians with low incomes are also more likely than other residents to report nonfinancial barriers to accessing health care, such as long wait times to get an appointment. A majority of Californians with low incomes say their community does not have enough mental health providers, and about four in ten say their community lacks enough primary care doctors and specialists to meet the needs of residents.
• The distinctive health care experience of Californians with low incomes is also evident in their attitudes toward Medi-Cal. While overwhelming majorities of Californians across income levels say Medi-Cal is important to the state, Californians with low incomes are twice as likely as those with higher incomes to say the program is important to them and their families.