Data Brief | No. 63 | February 2020

Illinois Adults Struggle to Afford High Healthcare Costs; Support a Range of Government Solutions Across Party Lines

Nationally, consumer worry about healthcare affordability is well documented but now—for the first time—a new survey reveals how affordability concerns and ideas for action play out in Illinois.

A Range of Healthcare Affordability Burdens

Like many Americans, Illinois adults currently experience hardship due to high healthcare costs.  All told, 56% of Illinois adults experienced one or more of the following healthcare affordability burdens in the prior 12 months: 

1) Being Uninsured Due to High Premium Costs

• Almost half (45%) of uninsured adults cited “too expensive” as the major reason for not having coverage, far exceeding other reasons like “don’t need it” and “don’t know how to get it.

2) Delaying or Forgoing Healthcare Due to Cost

Half (49%) of Illinois adults encountered one or more cost related barriers to getting healthcare during the prior 12 months, including: 

• 30%—Skipped needed dental care
• 29%—Delayed going to the doctor or having a procedure done
• 26%—Skipped a recommended medical test or treatment
• 25%—Avoided going to the doctor or having a procedure done altogether
• 21%—Did not fill a prescription
• 19%—Cut pills in half or skipped doses of medicine

At lower rates, respondents also reported trouble getting mental healthcare and/or addiction treatment. Moreover, cost was by far the most frequently cited reason for not getting needed medical care, exceeding a host of other barriers like transportation, difficulty getting an appointment, lack of childcare and other reasons.

Of the various types of medical bills, the ones most frequently associated with an affordability barrier were doctor visits, dental and prescriptions, likely reflecting the frequency with which Illinois adults seek these services—or, in the case of dental, perhaps lower rates of coverage for these services.

3) Struggling to Pay Medical Bills

Other times, Illinois adults got the care they needed but then struggled to pay the resulting bill. About one-third (34%) of Illinois adults experienced one or more of these struggles while paying off medical bills:

• 13%—Contacted by a collection agency
• 12%—Used up all or most of their savings
• 10%—Unable to pay for basic necessities like food, heat, or housing
• 9%—Borrowed money or got a loan or another mortgage on home
• 8%—Racked up large amounts of credit card debt
• 5%—Placed on a long-term payment plan

High Levels of Worry About Affording Healthcare in the Future

In even greater numbers, Illinois adults worry about affording healthcare in the future. Overall, 4 out of 5 (81%) adults reported being “worried” or “very worried” about affording some aspect of healthcare in the future, including:

• 65%—Cost of nursing home and home care services
• 63%—Medical costs when elderly
• 62%—Cost of a serious illness or accident
• 54%—Cost of prescription drugs

In addition, most respondents (62%) were “worried” or “very worried” about not being able to afford health insurance in the future. The greatest concern was among those who buy private health coverage as individuals and those on Medicaid—more than two-thirds are worried (see Figure 1). In addition, those on Medicaid and individual market enrollees were worried about losing their coverage.

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Regional Differences in Healthcare Affordability Burdens 

The survey also revealed some regional differences in how Illinoisians experience healthcare affordability burdens. Responses were grouped into three regions shown in Figure 2.

The Greater Illinois areas (beyond the Cook and Collar Counties) reported the greatest rate of healthcare affordability burdens—fifty-nine percent of adults had one or more of the three types of burdens described above. This is consistent with this region having the lowest median income. Cook County and the Collar Counties were not far behind; however, more than half of respondents reported trouble affording healthcare (See Figure 2).  

In contrast, most areas of Illinois were very worried about affording healthcare in the future. Only the Collar Counties reported somewhat lower levels of worry.

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Dissatisfaction with the Health System and Support for Change

In light of these healthcare affordability concerns, it is not surprising that Illinois adults were extremely dissatisfied with the health system. Statewide: 

• Just 28% agreed or strongly agreed with the statement “We have a great healthcare system in the U.S.,”
• While 70% agreed or strongly agreed “the system needs to change.” 

The survey asked about both personal and governmental actions to address healthcare system problems. 

Personal Actions

llinois adults do see a role for themselves in addressing healthcare affordability. When asked to rank the three personal actions that would be most effective in addressing the affordability of healthcare (out of ten options), top vote getters were:

• 64%—Taking better care of their personal health
• 39%—Write or call my STATE representative asking them to take action
• 35%—Write or call my FEDERAL representative asking them to take action
• 35%—Research treatments myself, before going to the doctor

They also reported specific actions they have already taken, like researching the cost of a drug beforehand (60%), as well as action they should be taking—78% said they would switch from a brand to a generic drug if given a chance.

Government Actions

But far and away, Illinois residents see government as the key stakeholder that needs to act to address health system problems. Moreover, addressing healthcare problems trumps other issues that Wisconsinites want their elected representatives to work on. 

At the beginning of the survey, respondents were asked what issues the government should address in the upcoming year. Healthcare was the most frequently cited issue, far exceeding the other eight options. The top vote getters were:

• 64%—Healthcare
• 49%—Taxes
• 39%—Economy/Joblessness

When asked about the top three healthcare priorities the government should work on, top vote getters were:

• 52%—addressing high healthcare costs, including prescription drugs 
• 37%—preserving consumer protections like: you can’t be denied coverage or charged more if you have a pre-existing medical condition
• 35%—getting health insurance to those who cannot afford coverage

Of more than 20 options, Illinois adults believe the reason for high healthcare costs is unfair prices charged by powerful industry stakeholders:

• 72%—Drug companies charging too much money 
• 66%—Hospitals charging too much money 
• 62%—Insurance companies charging too much money 
• 53%—Some well-known or large hospitals or doctor groups using their influence to get higher payments from insurance companies 

When it comes to tackling costs and other consumer problems, respondents endorsed a number of strategies, including: 

• 90%—Make it easy to switch insurers if a health plan drops your doctor
• 90%—Show what a fair price would be for specific procedures
• 90%—Require insurers to provide upfront cost estimates to consumers

Support for Action Across Party Lines

What is remarkable about the findings is high support for change regardless of respondents' political affiliation (see Table 1). 

The high burden of healthcare 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 or not progress is being made.

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Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ unbiased views on a wide range of health system issues, including confidence using the health system, financial burden, and views on fixes that might be needed. 

The survey used a web panel from Dynata with a demographically balanced sample of approximately 1,047 respondents who live in Illinois. The survey was conducted only in English and restricted to adults ages 18 and older. Sample balancing occurred in age, gender and income to be demographically representative of Illinois. The demographic composition of respondents was as follows.

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