Californians and their families finance every dollar flowing into the health care system through premiums and deductibles, forgone wages, and taxes. Given that health care spending is increasing, the burden on Californian families is rising. For example, Californians with employer coverage have been shouldering an increasing portion of annual premiums. Workers’ contributions toward premiums more than doubled from 2000 through 2017; they more than tripled for those at firms with fewer than 25 workers.

Between 2012 and 2020, the percentage of California workers with family coverage who had a large deductible (over $2,000) more than doubled, from 31% to 70%.

Health care has simply become unaffordable for far too many. This is one more driver of inequality in the state, as Californians with lower incomes and Black and Latino/x Californians are most affected.  For example, more than a quarter of Californians said that they or someone in their family had problems paying medical bills in 2023. Californians who are Latino/x, Black, multiracial, have low incomes, or speak Spanish were most likely to experience this problem.

More than one in three Californians reported medical debt in 2023. More than half of Californians who are Black, speak Spanish, or have low incomes – and nearly half of Latino/x Californians – reported medical debt.

Half of Californians said they or a family member skipped health care in 2023 due to cost; many said this made their health condition worse.

The rate was much higher for Californians with low incomes.