A survey of more than 1,400 Louisiana adults, conducted from July 19 to July 29, 2023, found that:
Like many Americans, Louisiana adults experience hardship due to high healthcare costs. All told, over
two-thirds (67%) of respondents experienced one or more of the following healthcare affordability
burdens in the prior 12 months:
1) Being Uninsured Due to High Premium Costs
Over one-third (35%) of uninsured respondents 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
Over half (60%) of all respondents reported delaying or going without healthcare during the prior 12
months due to cost:
Moreover, of respondents who reported a delay or foregoing healthcare, the most cited reason for them
or a family member not getting needed medical care in the past year was cost, exceeding a host of other
barriers like getting an appointment, getting time off work, transportation and lack of childcare.
3) Struggling to Pay Medical Bills
Other times, respondents got the care they needed but struggled to pay the resulting bill. Over two in
five (43%) experienced one or more of these struggles to pay their medical bills:
Of the various types of medical bills, the ones most frequently associated with an affordability barrier
were doctor bills, dental bills and prescription drugs. The high prevalence of affordability burdens for
these services likely reflects the frequency with which Louisiana respondents seek these services. Trouble paying for dental bills likely reflects lower rates of coverage for these services.
Louisiana respondents also exhibit high levels of worry about affording healthcare in the future. Over
three in four (78%) reported being “worried” or “very worried” about affording some aspect of healthcare
in the future, including:
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 respondents ages 45-54. This finding suggests that Louisiana respondents may be
worried about affording the cost of care for both aging relatives and themselves.
Worry about affording healthcare was highest among respondents living in lower- and middle-income
households and among those living in households with a person with a disability (see Table 1). More than 4 in 5 (88% of) respondents with household incomes of less than $75,000 per year2 reported worrying
about affording some aspect of coverage or care in the past year. Still, most Louisiana respondents of all
incomes, races, ethnicities, geographic setting and levels of ability are somewhat or very concerned.
Concern that health insurance will become unaffordable is also more prevalent among certain groups of
Louisiana respondents. By insurance type, respondents with Louisiana Medicaid most frequently reported
worrying about affording coverage, followed by respondents with coverage through their employer (see
Respondents with household incomes below $75,000 per year reported the highest rates of worry about
losing coverage, as well as the highest rates of worry about affording coverage. Black/African American
respondents and those living in households with a person with a disability reported higher rates of both
worrying about losing insurance and worry about health insurance becoming unaffordable in the future
compared to white alone, non-Hispanic respondents and those not living with a disabled household
member (see Table 2). Respondents with Medicaid and those purchasing health insurance on their own
(such as through the health insurance marketplace) reported the highest rates of worrying about losing
their insurance compared to those with employer-based insurance or Medicare. Concerns about affording
coverage exceeded fears about losing coverage across all income groups, disability statuses, geographic
settings, race, ethnicity and coverage types.
The survey also revealed differences in how Louisiana respondents experience healthcare affordability
burdens by income, age, geographic setting and disability status.
Income and Age
Unsurprisingly, respondents at the lower end of the income spectrum most frequently reported
experiencing one or more healthcare affordability burdens, with 75% of those earning less than $75,000 per year reporting struggling to afford some aspect of coverage or care in the past 12 months (see Figure 2). This may be due, in part, to respondents in this income group reporting higher rates of going without care and rationing their medication due to cost (see Figure 3). Still, 57% of those earning more than $100,000 per year reported experiencing affordability burdens, demonstrating that people across the income spectrum experience these challenges.
Further analysis found that Louisiana respondents ages 18-44 reported higher rates of going without care
due to cost than respondents ages 45 and up (see Figure 4). In addition, respondents ages 18-44 also
more frequently reported rationing medication due to cost compared to other age groups.
Respondents living in households with a person with a disability reported the highest rates of going
without care and rationing medication due to cost in the past 12 months. Over 3 in 4 (77% of) respondents
in this group reported going without some form of care and 49% reported rationing medication,
compared to 56% and 28% of respondents living in households without a person with a disability,
respectively (see Table 4). Respondents living in households with a person with a disability also more
frequently reported delaying or skipping getting mental healthcare, addiction treatment and dental care,
among other healthcare services, than those in households without a person with a disability due to cost
concerns (see Table 3).
Those with disabilities may also face healthcare affordability burdens unique to their disabilities—35% of
respondents reporting a disability in their household reported delaying getting a medical assistive device
such as a wheelchair, cane/walker, hearing aid or prosthetic limb due to cost. Just 10% of respondents
without a person with a disability (who may have needed such tools temporarily or may not identify as
having a disability) reported having this experience.
Louisiana respondents of color reported higher rates of rationing medication and forgoing care than
white respondents. Fifty-nine percent of respondents of color reported going without care due to
cost, compared to 55% of white respondents (see Table 3). Further analysis showed that respondents
of color also reported slightly higher rates of challenges receiving mental health care, challenges
receiving addiction treatment and skipping needed dental care (see Figure 5).
Respondents with health insurance they bought on their own reported the highest rates of going without
care due to cost and rationing medication, followed by respondents with Louisiana Medicaid coverage and
those with employer-sponsored insurance (see Table 4). Still, over half of respondents with Medicare went
without care due to cost in the twelve months prior to taking the survey.
Survey respondents also had the opportunity to share their own stories about going without care due to
cost in the past year. Notably, respondents with both private insurance and Medicaid reported challenges
affording care (see Table 5).
Race and Ethnicity
Louisiana respondents of color reported slightly higher rates of rationing medication and forgoing care
than white respondents. Sixty-one percent (61%) of respondents of color went without care due to cost,
including 69% of Hispanic/Latino respondents, compared to 59% of white alone, non-Hispanic
respondents (see Table 4). Further analysis showed that Hispanic/Latino respondents reported higher
rates of challenges receiving mental health care and avoiding going to the doctor or getting a procedure
altogether (see Figure 5).
Encountering Medical Debt
The survey also showed differences in the prevalence of financial burdens due to medical bills, including
going into medical debt, depleting savings and being unable to pay for basic necessities (like food, heat
and housing) by income, race, ethnicity, disability status and geographic setting. Fifty-four percent of
respondents of color reported going into debt, depleting savings or going without other needs due to
medical bills, including 60% of Hispanic/Latino respondents, compared to 42% of white respondents (see
The rate of financial burden is even higher for respondents who have or live with a person with a disability,
with over 3 in 5 (65%) reporting going into debt or going without other needs due to medical bills,
compared to 30% of respondents living in households without a disabled member. In addition,
respondents with Louisiana Medicaid and those who purchased health insurance on their own reported the highest rate of the above financial burdens due to medical bills (48% and 47%, respectively) compared to those with other insurance types.
In addition to the above healthcare affordability burdens, some Louisiana respondents have been impacted by health system consolidation. In between 2019, 2020, and 2022 nineteen hospitals in the state changed ownership through either a merger, acquisition, or change of ownership (CHOW).3,4
Relative to other states, Louisiana has strict regulations surrounding hospital change of ownership, with provisions requiring notice, review or approval of any health care acquisitions mergers or consolidations. Such as anti-competitive contract terms, certificate of need, and certificate of public advantage approvals.5
In the past year, 12% of all respondents reported that they or a family member were unable to access their preferred health care organization because of a merger that made their preferred organization out-of-
network. Out of those who reported being unable to access their preferred healthcare provider due to a
Out of those who reported that the merger caused an additional burden for them or their families, when
asked about the greatest burden hospital mergers had created for respondents and their families, the top
three most frequently reported issues were:
In light of Louisiana respondents’ healthcare affordability burdens and concerns, it is not surprising that
they are dissatisfied with the health system:
To investigate further, the survey asked about both personal and governmental actions to address health
Louisiana respondents see a role for themselves in addressing healthcare affordability. When asked about
specific actions they could take:
When asked to select the top three personal actions they felt would be most effective in
addressing healthcare affordability (out of ten options), the most common responses were:
But far and away, Louisiana respondents see government as the key stakeholder that needs to act to
address health system problems. Moreover, addressing healthcare 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. The top vote getters were:
When asked about the top three healthcare priorities the government should work on, the top vote getters were:
Of more than 20 options, Louisiana respondents believe the reason for high healthcare costs is unfair
prices charged by powerful industry stakeholders:
When it comes to tackling costs, respondents endorsed a number of strategies, including:
There is also remarkable support for change regardless of respondents' political affiliation (see Table 7).
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 COVID crisis has led 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 progress is being made.
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.
This survey, conducted from July 19 to July 29, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,507 respondents who live in Louisiana. 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 1,417 cases for analysis. After those exclusions, the demographic composition of respondents was as follows,
although not all demographic information has complete response rates: