Data Brief | | November 2024

Idaho Survey Respondents Struggle to Afford High Healthcare Costs; Worry about Affording Health Care in the Future; Support Government Action Across Party Lines

Key Findings

A survey of more than 1,300 Idaho adults, conducted from September 6 to September 30, 2024,
found that:

• Over 4 in 5 (81%) experienced at least one health care affordability burden in the past year;
• 4 in 5 (80%) worry about affording health care in the future;
• Nearly 4 in 5 (79%) of all respondents delayed or went without health care due to cost in the last twelve months;
• Respondents with low-income and those with disabilities had higher rates of going without care due to cost and incurring medical debt, depleting savings, and/or sacrificing basic needs due to medical bills; and
• Across party lines, respondents express strong support for government-led solutions.

A Range of Health Care Affordability Burdens

Like many Americans, Idaho adults experience hardship due to high health care costs. In the past twelve
months, 8 out of 10 (81%) respondents experienced at least one of the following health care affordability
burdens:

1) Being Uninsured Due to High Costs

Nearly 2 in 5 (38%) uninsured respondents cited cost (“too expensive”) as the primary reason for being
uninsured, surpassing other potential responses such as “don’t need it” and “don’t know how to get it.”
Likewise, 46% of respondents without dental insurance and 36% of those without vision insurance cited
cost as the main reason for not having coverage.

2) Delaying or Going Without Health Care Due to Cost

Nearly 4 in 5 (79%) of all respondents reported delaying or going without health care during the prior 12
months due to cost:

• 33%—Cut pills in half, skipped doses of medicine or did not fill a prescription¹
• 26%—Skipped needed dental care
• 25%—Skipped a recommended medical test or treatment
• 24%—Delayed going to the doctor or having a procedure done
• 19%—Had problems getting mental health care or addiction treatment²
• 18%—Skipped needed vision services
• 15%—Avoided going to the doctor or having a procedure done altogether
• 9%—Skipped needed hearing services
• 6%—Skipped or delayed getting a medical assistive device

Moreover, respondents most frequently cited cost as the reason for them or their family members not
getting care in the last year (25%) followed by not being able to get an appointment (18%), exceeding a
host of other barriers like getting time off work, transportation, and lack of childcare.

3) Struggling to Pay Medical Bills

Other times, respondents got the care they needed but experienced a cost burden due to the resulting
medical bill(s). Nearly half (47%) of respondents reported experiencing one or more of these struggles to
pay their medical bills:

• 18%—Were contacted by a collection agency
• 18%—Were unable to pay for basic necessities like food, heat or housing
• 16%—Used up all or most of their savings
• 16%—Borrowed money, got a loan, or another mortgage on their home
• 12%—Racked up large amounts of credit card debt
• 10%—Were placed on a long-term payment plan
• 7% - Asked for donations (GoFundMe campaigns)

High Levels of Worry About Affording Health Care in the Future

Idaho respondents also exhibit high levels of worry about affording health care in the future. Four in five
(80%) reported being “worried” or “very worried” about affording some aspect of health care in the
future, including:

• 63%—Cost of nursing home or home care services
• 63%—Health insurance will become unaffordable
• 62%—Medical costs when elderly
• 61%—Medical costs in the event of a serious illness or accident
• 57%—Prescription drugs will become unaffordable
• 57%—Cost of dental care
• 51%—Cost of needed vision services
• 50%—Cost of needed hearing services

While two of the most common worries—affording the cost of nursing home or home care services and
medical costs when elderly—are applicable predominantly to an older population, they were most
frequently reported by younger respondents. Respondents aged 18-24 and those 45-64 reported the
highest worry about medical costs in old age. Those aged 35-54 were most concerned about affording
nursing home or home care costs. This suggests that Idaho respondents may be worried about affording
the cost of care for both aging relatives and themselves.

Likewise, worry about affording health care was highest among respondents living in low-income
households, those with a disabled household member, and those in the non-rural areas (see Table 1).
Overall, 87% of respondents with an annual household income between $75,000 and $100,000 reported
worrying about affording some aspect of coverage or care in the past year. However, 72% of those
earning over $100,000 per year also reported concerns.³ In fact, concerns were consistent across all
respondent income levels, education levels, races, ethnicities, geographic settings, and abilities.

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Respondents reported worry about insurance becoming unaffordable more frequently than worry about
losing coverage across all income levels, regions, races/ethnicities, and coverage types.

Concern that health insurance will become unaffordable was most prevalent among those with insurance
purchased independently (see Figure 1), those earning $75,000 - $100,000, and those in non-rural areas.
Likewise, respondents of color and those living in a household that includes a person with a disability also
reported the highest rates of concern that health insurance will become unaffordable (see Table 2).

Although concerns about affording coverage surpassed fears about losing coverage, certain respondents
were more concerned about losing health insurance coverage than others. Concerns about losing health
insurance coverage were most prevalent among those with insurance purchased independently (see
Figure 1), those earning $75,000 - $100,000, those in rural areas, and those with a disabled household
member compared to their respective counterparts (see Table 2).

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Differences in Health Care Affordability Burdens

The survey also revealed differences in how Idaho respondents experience health care affordability burdens by income, age, geographic setting, disability, race and ethnicity.

Income and Age

Respondents at the lower end of the income spectrum most frequently reported experiencing one or more
health care affordability burdens. Over 4 out of 5 (85%) respondents earning less than $75,000 per year
reported struggling to afford some aspect of coverage or care in the past 12 months (see Figure 2).
Respondents earning less than $75,000 also reported higher rates of going without care and rationing theirmedication due to cost (see Figure 3).

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Further analysis found that Idaho respondents aged 25-34 reported the highest rates of forgoing care due
to cost. However, at least half of respondents aged 18-64 reported going without care due to financial
barriers, signaling that the issue extends across age groups. Likewise, respondents aged 18-44 most
frequently reported rationing medication due to cost compared to other age groups (see Figure 4).

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Disability

Respondents living in households with a person with a disability reported the highest rates of forgoing
care and rationing medication due to cost. Of those included in this group, 84% reported going without
some form of care and 41% reported rationing medication due to cost in the past year. In contrast, fewer
respondents living in a household without a person with a disability reported forgoing care (77%) and
rationing medication (28%) due to cost (see Table 4).

Additionally, respondents living in households with a person with a disability more frequently reported
skipping necessary mental health, addiction treatment, vision and dental care services due to cost
compared to respondents living in households without a person with a disability (see Table 3).

Those with disabilities also face health care affordability burdens unique to their disabilities— 8% of
respondents with a disabled household member reported delaying getting a medical assistive device such
as a wheelchair, cane/walker, hearing aid, or prosthetic limb due to cost. Only 5% of respondents in
households without a disabled person reported this experience.

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Insurance Type

People with different types of insurance navigate the health care system in varying ways. Those with
private insurance may face higher premiums and out-of-pocket costs, while individuals enrolled in Medicaid or Medicare generally have lower costs but may encounter limited provider options, greater
restrictions around covered services, and longer wait times for services.

In Idaho, respondents enrolled in Medicaid reported the highest rates of going without care due to cost
and rationing medication, followed by respondents with private insurance purchased independently (see
Table 4). Still, well over half (63%) of respondents with Medicare coverage also went without care due to
cost in the twelve months prior to taking the survey.

Race and Ethnicity

White alone, Non-Hispanic respondents reported going without care due to cost more frequently than
respondents of color. Conversely, respondents of color reported rationing medication due to financial
concerns at higher rates than white respondents. There are a variety of potential consequences related to
postponing health care and medication rationing, highlighting the importance of addressing cost-related
barriers to address health disparities.

In Idaho, 80% of White, Non-Hispanic/Latino respondents reported going without care due to cost in the
past twelve months compared to 77% of respondents of color (see Table 4). Further analysis however,
showed that respondents of color reported higher rates of skipping dental services, vision services, and
recommended medical tests or treatments (see Figure 5).

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In an effort to explore the impact high health costs have on individuals, respondents were also asked to
describe a time that they were unable to get health care due to cost (see Table 5). These anecdotes
highlight affordability challenges, underscore the impact of health care costs on individuals, and
emphasize the need for solutions to reduce financial barriers to care.

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Encountering Medical Debt

In the absence of affordable care options, individuals may find themselves burdened by medical costs. To
explore the impact of unaffordable medical care, survey participants were asked whether they have had to
do any of the following due to the cost of medical bills in the past twelve months: use up all or most of
their savings; sacrifice basic necessities, such as food, heat, or housing; borrow money, get a loan or take
out another mortgage; use a crowdfunding platform to solicit donations; interact with a collections
agency; go into credit card debt; be placed on a long-term payment plan; or declare bankruptcy.

The survey results revealed that respondents of color reported experiencing at least one of the previous
medical cost burdens more frequently than white respondents. Likewise, respondents who have or live
with a person with a disability also reported navigating medical cost burdens more frequently than
respondents without a disabled household member, and respondents with insurance purchased
independently reported the highest rates of the above burdens due to medical bills (62%) compared to
respondents with all other insurance types (see Table 6).

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Impact and Worry Related to Hospital Closures*

In the past year, 27% of respondents reported that they were aware of closures or acquisition in their
community—of those respondents, 37% reported that they or a family member were unable to access
their preferred health care organization because of a closure that made their preferred organization out-
of-network. Out of those who reported being unable to access their preferred health care provider due to
a closure:

• 34% delayed or avoided going to the doctor or having a procedure done because they could no longer access their preferred health care organization due to a closure,
• 37% skipped recommended follow-up visits due to a closure,
• 31% changed their preferred doctor or hospital to one that is in-network, and
• 25% - skipped filling a prescription medication.

Out of those who reported that the closure caused an additional burden for them or their families, the top
three most frequently reported issues were:

• 29% — The closure created an added wait time when searching for a new provider
• 22% — The closure created an added financial burden
• 19% — The closure created a gap in the continuity of my care

While a smaller portion of respondents reported being unable to access their preferred health care
organization because of closure, far more respondents (79%) reported being “somewhat”, “moderately”
or “very worried” about the impacts of closures in their health care organizations. When asked about their
largest concern respondents most frequently reported:

• 31% — I’m concerned I will have fewer choices of where to receive care
• 19% — I’m concerned my doctor may no longer be covered by my insurance
• 19% — I’m concerned I will have to travel farther to see my doctor
• 18% — I’m concerned I will have to pay more to see my doctor
• 9% — I’m concerned I will have a lower quality of care

Dissatisfaction with the Health System and Support for Change

In light of Idaho respondents’ health care affordability burdens and concerns, it is not surprising that they
are dissatisfied with the health system. Of the respondents surveyed:

• Just 38% “agreed” or “strongly agreed” that “we have a great healthcare system in the U.S.,”
• While 68% “agreed” or “strongly agreed” that “the system needs to change."

To investigate further, the survey asked respondents to share their perspectives on both personal and
governmental actions to address the high health costs.

Personal Actions

Idaho respondents see a role for themselves in addressing health care affordability. When asked about
specific actions they could take:

• 62% of respondents reported researching the cost of a drug beforehand, and
• 67% said they would be willing to switch from a brand name to an equivalent generic drug if given the chance.

When asked to select the top three personal actions they felt would be most effective in
addressing affordability (out of ten options), the most common responses were:

• 63% — Take better care of my personal health
• 39% — Research treatments myself before going to the doctor
• 36% — Do more to compare provider cost and quality before getting services
• 25% — Contact my state representatives asking them to address high health care prices and lack of affordable coverage options
• 21% — There is nothing I can do personally to make our health system better
   

Government Actions

Idaho respondents see government as the key stakeholder that needs to act to address health system
problems. Moreover, addressing health care problems is one of the top priorities that respondents want
their elected officials to work on. At the beginning of the survey, respondents were asked what issues the
government should address in the upcoming year. Respondents most frequently chose:

• 53% — Health Care
• 43% — Economy/Joblessness
• 34% — Affordable Housing

When asked about the top three health care priorities the government should address, respondents most
frequently chose:

• 46% — Address high health care costs such as prescription drug costs, health insurance, etc.(Republican: 40%, Democrat: 41% Neither: 58%)
• 31% — Preserve consumer protections preventing people from being denied coverage or charged more for having a pre-existing medical condition (Republican: 31%, Democrat: 32% Neither: 33%)
• 29% — Provide health insurance to those who cannot afford coverage (Republican: 31%, Democrat:
• 24% Neither: 33%)

Out of fifteen possible options, Idaho respondents most frequently reported believing that the reason for
high health care costs is unfair prices charged by powerful industry stakeholders, such as:

• 64% — Drug companies charging too much money (Republican: 62%, Democrat: 60% Neither: 70%)
• 63% — Insurance companies charging too much money (Republican: 57%, Democrat: 59% Neither: 70%)
• 62% — Hospitals charging too much money (Republican: 60%, Democrat: 61%, Neither: 69%)

When it comes to tackling costs, respondents endorsed a number of strategies, including:

• 93% — Show what a fair price would be for specific procedures
• 92% — Require drug companies to provide advance notice of price increases and information to justify those increases.
• 91% — Require hospitals and doctors to provide up-front cost estimates to consumers
• 91% — Require insurers to provide up-front cost estimates to consumers
• 91% — Cap out-of-pocket costs for life-saving medications, such as insulin
• 90% — Set standard prices for drugs to make them affordable
• 90% — Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes
• 89% — Make it easy to switch insurers if a health plan drops your doctor (for example, have the government increase or maintain subsidies to help consumers purchase health insurance on the Marketplace Exchange)

Support for Action Across Party Lines

There is remarkable support for change regardless of respondents' political affiliation (see Table 7). The
high burden of health care affordability, along with high levels of support for change, suggest that elected
leaders and other stakeholders need to make addressing this consumer burden a top priority. Annual
surveys can help assess whether progress is being made.

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Notes

1. Of the 81% of respondents who encountered one or more cost-related barriers to getting health care during the past twelve months, 23% did not fill a prescription and 15% cut pills in half or skipped doses of medicine due to cost.
2. Thirteen percent (13%) had problems getting mental health care and 8% had problems getting addiction treatment.
3. Median household income in Idaho is $70,214 (2018-2022). U.S. Census, Quick Facts. Retrieved from: U.S. Census Bureau QuickFacts, U.S. Census Bureau QuickFacts: Idaho.
4. The Source on Healthcare Price and Competition, Merger Review, Retrieved August 23, 2023 from
   https://sourceonhealthcare.org/market-consolidation/merger-review/

Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions. This survey, conducted from September 6 to September 30, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,300 respondents who live in Idaho. Information about Dynata’s recruitment and compensation methods can be
found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,365 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

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