Data Brief | No. 73 | August 2020

Kentucky Residents Struggle to Afford High Healthcare Costs; COVID-19 Fears Add to Support for a Range of Government Solutions Across Party Lines

 

Key Findings A survey of 1,140 Kentucky adults, conducted from May 8, 2020 to May 26, 2020, found that: More than half (58%) experienced healthcare affordability burdens in the past year; Over three-quarters (77%) are worried about affording healthcare in the future; High numbers are worried about becoming ill from COVID; and Across party lines, they express strong support for government-led solutions.

 

A Range of Healthcare Affordability Burdens

Like many Americans, Kentucky adults currently experience hardship due to high healthcare costs. All told, 58% of Kentucky adults experienced one or more of the following healthcare affordability burdens in the prior 12 months: 

1) Being Uninsured Due to High Premium Costs

• 18% of adult respondents were uninsured for all or part of the prior 12 months.
• 39% of uninsured adults cited “too expensive” as the major reason for not having coverage, far exceeding other reasons, like “don't need it” and “didn't qualify for open enrollment on the exchange.”

2) Delaying or Forgoing Healthcare Due to Cost

Fifty-one percent of Kentuckians encountered one or more cost-related barriers to getting healthcare during the prior 12 months: 

• 30%—Delayed going to the doctor or having a procedure done
• 29%—Skipped needed dental care
• 24%—Skipped a recommended medical test or treatment
• 24%—Avoided going to the doctor or having a procedure done altogether
• 23%—Did not fill a prescription
• 20%—Cut pills in half or skipped doses of medicine
• 12%—Had problems getting mental healthcare

At lower rates, respondents also reported trouble getting 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 and lack of childcare. 

Of the various types of medical bills, the ones most frequently associated with an affordability barrier were doctor bills, dental bills and prescription drugs, likely reflecting the frequency with which Kentucky 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, Kentuckians got the care they needed but struggled to pay the resulting bill. One out of three Kentucky adults (32%) experienced one or more of these struggles to pay their medical bills: 

• 14%—Contacted by a collection agency
• 9%—Used up all or most of their savings 
• 8%—Unable to pay for basic necessities like food, heat or housing
• 8%—Borrowed money, got a loan or another mortgage on their home
• 7%—Racked up large amounts of credit card debt
• 7%—Placed on a long-term payment plan

High Levels of Worry About Affording Healthcare in the Future

In even greater numbers, Kentucky adults worry about affording healthcare in the future. Overall, more than three-fourths (77%) 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
• 61%—Medical costs when elderly
• 59%—Cost of a serious illness or accident
• 53%—Cost of prescription drugs
• 51%—Cost of dental care

In addition, 61% of respondents are “worried” or “very worried” about not being able to afford health insurance in the future. These concerns vary by type of insurance coverage, with those on Medicaid being most concerned about losing their coverage. Most Kentuckians are concerned about affording health insurance in the future, regardless of their coverage type (see Figure 1). 

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Regional Differences in Healthcare Affordability Burdens

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

The Eastern Kentucky region reported the greatest rate of healthcare affordability burdens—68% of adults had one or more of the three categories of burdens described above. This is consistent with this region having the lowest median income. In the other four regions, more than half of respondents reported trouble affording healthcare (see Figure 2).

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Perhaps reflecting this high rate of healthcare affordability burdens, residents of Eastern Kentucky also reported starkly higher levels of worry:

• Worry about affording prescription drugs spiked at 63% for Eastern Kentucky, compared to 50% for the remaining regions.
• Worry about affording the costs of a serious illness or accident was 71% for Eastern Kentucky, compared to 56% for remaining regions.
• Overall worry of affording any healthcare burden was highest in Eastern Kentucky at 84%, compared to lower levels in the rest of the state.

More detail is available in the 2020 regional Kentucky reports, which can be found at: www.healthcarevaluehub.org/advocate-resources/kentucky-healthcare-survey

COVID-19 Worries

In addition to affordability worries, new questions were asked about respondents' top worries related to the COVID crisis.¹ When asked if worried about “affording treatment of coronavirus/COVID-19 if you need it,” 59% of respondents were “worried” or “very worried.” 

Separately, out of twelve possible responses, respondents were asked to pick the top three things they were most worried about (see Figure 3). “Becoming ill from the virus,” not only ranked as the top worry among the choices, but it exceeded other worries by a wide margin, garnering almost twice as many “votes” as the next most common worry, “Job loss and resulting lack of wages.”

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Dissatisfaction with the Health System and Support for Change

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

• Just 27% agreed or strongly agreed that “we have a great healthcare system in the U.S.,”
• While 71% agreed or strongly agreed that “the system needs to change." 

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

Personal Actions

Kentucky 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:

70%—Taking better care of my personal health

37%—Research treatments myself, before going to the doctor

36%—Write or call my STATE representative asking them to take action

32%—Write or call my FEDERAL representative asking them to take action

They also reported specific actions they have already taken, like researching the cost of a drug beforehand (59%), as well as action they should be taking—80% said they would switch from a brand to a generic drug if given a chance.

Government Actions

Additionally, Kentucky residents see government as the key stakeholder that needs to act to address health system problems. Moreover, addressing healthcare problems trumps other issues that Kentuckians 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. The top vote getters were:

• 69%—Healthcare
• 67%—Economy/Joblessness
• 34%—Taxes

The economic woes brought on by the COVID crisis likely contributed to “Economy/Joblessness” as a primary concern, but healthcare remained the top issue that Kentucky adults want their elected representatives to work on. 

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

• 55%—Address high healthcare costs, including prescription drugs 
• 33%—Preserve consumer protections like: you can't be denied coverage or charged more if you have a pre-existing medical condition
• 31%—Get health insurance to those who cannot afford coverage
• Of more than 20 options, Kentuckians believe the reason for high healthcare costs is unfair prices charged by powerful industry stakeholders:
• 74%—Drug companies charging too much money 
• 69%—Hospitals charging too much money 
• 65%—Insurance companies charging too much money 
• 54%—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, respondents endorsed a number of strategies, including: 

• 91%—Expand health insurance options so that everyone can afford quality coverage
• 90%—Require insurers to provide up-front cost estimates to consumers
• 90%—Show what a fair price would be for specific procedures
• 89%—Make it easy to switch insurers if a health plan drops your doctor
• 89%—Ensure the cost of widely needed vaccines are affordable for all
• 89%—Require hospitals and doctors to provide up-front cost estimates to consumers
• 89%—Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug hikes
• 89%—Ensure patients can't be charged out-of-network prices if they encounter an out-of-network provider through no fault of their own
• 88%—Prohibit drug companies from charging more in the U.S. than abroad
• 88%—Require drug companies to provide advanced notice of price increases and information to justify those increases

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). 

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Policies to Address COVID-19 Concerns

In addition to residents' views on the policies and approaches above, new questions were asked about support for and against policies related to the COVID crisis. Out of eleven possible responses, respondents were asked to pick the top three policies that would help address COVID-related problems. There was significant diversity in the policies supported, with the front runner, “Additional federal stimulus payments,” closely followed by four almost equally ranked options: “More financial help for small businesses,” “Improved public health emergency preparedness,” “Universal health coverage for all,” and “Price limits on needed vaccines” (see Figure 4). The least supported policy was “More financial help for large businesses.” 

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Far fewer respondents answered when asked about policies they did NOT support. Among the
responses we received, 23% indicated that they did not support “More financial help for large
businesses.” Trailing behind that (with 17% of the votes) was “Universal health coverage for all,” although more votes were cast overall in support. In this area, there was a lack of agreement across party lines, with Republicans far more likely to NOT support “Universal health coverage for all” as a means to address COVID concerns, compared to Democrats and those not affiliated with either party (see Table 2). It is important to note, however, that when asked generically about “Expanding health insurance options so that everyone can afford quality coverage,” 91% of respondents agreed or strongly agreed with this policy as a means of improving affordability.

When asked about the policies they did NOT support, respondents were given the option of selecting “I support all of the policies listed.” Nineteen percent of respondents selected this option.

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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. Moreover, the current COVID crisis is leading state residents to take a hard look at how well health and public health systems are working for them, with strong support for a wide variety of actions. Annual surveys can help assess whether or not progress is being made.

Comparing 2020 Results to the 2018 CHES Survey

We caution readers against drawing strong conclusions about changes observed between the 2018 and 2020 CHES surveys. While the findings from the two surveys are remarkably consistent, small
differences in the weighting approach and in the instrument itself (most significantly the addition of the COVID questions) indicate that direct comparisons should not be made.  For more information on the Kentucky state surveys, go to www.healthcarevaluehub.org /kentucky-healthcare-survey.

Note

1. COVID-19 is the disease caused by the Coronavirus, which was characterized as a pandemic by the World Health Organization on March 11, 2020. For a comparison of how respondents from Kentucky and three other states answered our COVID questions, please see Healthcare Value Hub, How COVID Has Shaped Residents' Broader Attitudes Towards the Health System, Data Brief No. 86.

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 1,217 respondents who live in Kentucky. The survey was conducted only in English 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 1,140 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates: