Data Brief | | August 2024

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

Key Findings

A survey of more than 1,400 New Mexico adults, conducted from June 6 to July 8, 2024, found that:

• 3 in 4 (75%) experienced at least one health care affordability burden in the past year;
• Over 4 in 5 (82%) worry about affording health care in the future;
• Nearly 3 in 4 (73%) of all respondents delayed or went without health care due to cost in the last twelve months;
• Low-income respondents 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, New Mexico adults experience hardship due to high health care costs. In the past
twelve months, over seven out of ten (75%) respondents experienced at least one of the following health
care affordability burdens:

1) Being Uninsured Due to High Costs

Greater than one-third of (37%) 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, 39% of respondents without dental insurance and 37% 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 three-fourths (73%) of all respondents reported delaying or going without health care during the
prior 12 months due to cost:

• 32%—Cut pills in half, skipped doses of medicine or did not fill a prescription¹
• 30%—Skipped needed dental care
• 26%—Delayed going to the doctor or having a procedure done
• 26%—Skipped a recommended medical test or treatment
• 21%—Avoided going to the doctor or having a procedure done altogether
• 20%—Skipped needed vision services
• 19%—Had problems getting mental health care or addiction treatment²
• 8%—Skipped or delayed getting a medical assistive device
• 7%—Skipped needed hearing services

Respondents most frequently cited not being able to get an appointment (27%) as the reason for them or
their family members not getting care in the last year followed by cost (22%), 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). Over two out of five respondents (44%) reported experiencing one or more of these
struggles to pay their medical bills:

• 19%—Used up all or most of their savings
• 17%—Were unable to pay for basic necessities like food, heat or housing
• 16%—Were contacted by a collection agency
• 14%—Borrowed money, got a loan or another mortgage on their home
• 12%—Racked up large amounts of credit card debt
• 7%—Were placed on a long-term payment plan
• 7%—Asked for donations (e.g., GoFundMe campaigns)

High Levels of Worry About Affording Health Care in the Future

New Mexico respondents also exhibit high levels of worry about affording health care in the future. Over
four in five (82%) reported being “worried” or “very worried” about affording some aspect of health care
in the future, including:

• 67%—Cost of nursing home or home care services
• 66%—Medical costs when elderly
• 62%—Health insurance will become unaffordable
• 61%—Medical costs in the event of a serious illness or accident
• 59%—Cost of dental care
• 57%—Prescription drugs will become unaffordable
• 53%—Cost of needed vision services
• 49%—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 young adult respondents. Respondents aged 35-44 reported the highest worry
about medical costs in old age, and those aged 35-54 were most concerned about affording nursing home
or home care costs. This suggests that New Mexico respondents may be worried about affording the cost
of care for both aging relatives and themselves.

Some respondents also reported worrying about affording health care more than others. Respondents
with a disability or who live with a disabled household member, respondents enrolled in health insurance
coverage under Medicaid, and those living in Northwest New Mexico reported worrying about affording
some aspect of health care more frequently than others (see Table 1). Nearly nine in ten (87% of)
respondents with an annual household income between $50,000 and $75,000 reported worrying about
affording some aspect of coverage or care in the past year. However, 71% 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 through their employer (see Figure 1), those earning $75,000 - $100,000, and those in the
Northwest region of New Mexico. Likewise, Hispanic/Latino respondents 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 health insurance coverage through Medicaid
(see Figure 1), those earning less than $50,000, respondents living in the Northeast region of New Mexico, Hispanic/Latino respondents, and respondents living in a household that includes a person with a disability (see Table 2).

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Differences in Health Care Affordability Burdens

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

Income and Age

Respondents at the lowest end of the income spectrum most frequently reported experiencing one or more health care affordability burdens. Greater than four out of five (82%) respondents earning less than
$50,000 per year and respondents earning between $50,000 and $75,000 per year reported struggling to
afford some aspect of coverage or care in the past 12 months (see Figure 2). This may be related, in part, to respondents in these income groups reporting higher rates of going without care and rationing their
medication due to cost (see Figure 3).

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Further analysis found that New Mexico respondents aged 34-44 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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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 New Mexico, 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,
such as Marketplace plans (see Table 4). Still, nearly half (54%) of respondents with Medicare coverage
also went without care due to cost in the twelve months prior to taking the survey.

Disability

Respondents living in households with a person with a disability reported the highest rates forgoing care
and rationing medication due to cost. Of those included in this group, 85% reported going without some
form of care and 45% 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 (66%) and
rationing medication (24%) due to cost (see Table 4).

Additionally, respondents living in households with a person with a disability more frequently reported
skipping necessary 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— 13% 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 4% of respondents in households without a disabled person reported this
experience.

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Race and Ethnicity

Respondents of color reported going without care due to cost more frequently than white respondents.
Similarly, these respondents also reported rationing medication due to financial concerns at slightly higher
rates than white respondents. There are a variety of potential consequences related to postponing health
care and rationing medication, emphasizing the importance of addressing cost-related barriers to
achieving health equity.

In New Mexico, eighty-six percent (86%) of American Indian/Native Alaskan respondents reported going
without care due to cost in the past twelve months compared to 71% of white alone, non-Hispanic/Latino
respondent (see Table 4). Further analysis showed that respondents of color also reported higher rates of
skipping dental services, vision services, and recommended medical tests or treatments (see Figure 5).

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To explore the impact of high health costs, 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 a disability 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 Medicaid coverage reported the highest rates of the above burdens due to medical bills (55%) compared to respondents with all other insurance types (see Table 6).

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Impact of and Worry Related to Hospital Consolidation*

In addition to the above healthcare affordability burdens, a small share of New Mexico respondents
reported being negatively impacted by health system consolidation. Between 2021 to 2024, there have
been 3 changes in ownership involving hospitals through mergers, acquisitions, or CHOW in New
Mexico.^4,5 New Mexico does not require the State Attorney General be notified of hospital transactions.⁶

In the past year, 22% of respondents reported that they were aware of a merger or acquisition in their
community—of those respondents, 38% 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 merger:

• 45% skipped recommended follow-up visits due to a merger,
• 42% 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 merger,
• 36% changed their preferred doctor or hospital to one that is in-network,
• 33% skipped filling a prescription medication, and
• 27% changed health plan coverage to include their preferred doctor.

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

• 33%—The merger created an added wait time when searching for a new provider
• 21%—The merger created an added financial burden
• 14%—The merger created a gap in the continuity of my care
• 14%—The merger created an added transportation burden.

While a smaller portion of respondents reported being unable to access their preferred health care
organization because of a merger, more respondents (64%) reported being somewhat, moderately or very
worried about the impacts of mergers in their health care organizations. When asked about their largest
concern respondents most frequently reported:

• 30%—I’m concerned I will have fewer choices of where to receive care
• 23%—I’m concerned my doctor may no longer be covered by my insurance
• 18%—I’m concerned I will have to pay more to see my doctor
• 18%—I’m concerned I will have a lower quality of care
• 11%—I’m concerned I will have to travel farther to see my doctor

Dissatisfaction with the Health System and Support for Change

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

• Just 26% agreed or strongly agreed that “we have a great healthcare system in the U.S.,”
• While 79% agreed or strongly agreed that “the health care 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 Action
New Mexico respondents see a role for themselves in addressing health care affordability. When asked
about specific actions they could take:

• 54% of respondents reported researching the cost of a drug beforehand, and
• 77% 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 health care affordability (out of ten options), the most common responses were:

• 65%—Take better care of my personal health
• 42%—Research treatments myself before going to the doctor
• 30%—Do more to compare provider cost and quality before getting services
• 27%—Contact my state representatives asking them to address high health care prices and lack of affordable coverage options
• 25% — There is nothing I can do personally to make our health system better

Government Actions
New Mexico 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:

• 52%—Health care
• 47%—Economy/Joblessness
• 44%—Affordable Housing

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

• 45%—Address high health care costs, including prescription drugs
• 35%—Get health insurance to those who cannot afford coverage
• 30%—Improve Medicaid, coverage for low-income people
• 30%—Improve Medicare, coverage for seniors and those with serious disabilities

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

• 78%—Drug companies charging too much money
• 73%—Hospitals charging too much money
• 70%—Insurance companies charging too much money

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

• 95% — Show what a fair price would be for specific procedures
• 94% — Require hospitals and doctors to provide up-front cost estimates to consumers
• 94% — Require drug companies to provide advanced notice of price increases and information to justify those increases
• 93% — Require insurers to provide up-front cost estimates to consumers
• 93% — Cap out-of-pocket costs for life-saving medications, such as insulin
• 93% — Set standard prices for drugs to make them affordable
• 93% — Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes
• 92% — Make it easy to switch insurers if a health plan drops your doctor
• 92% — Create a Prescription Drug Affordability Board to examine and establish fair drug prices
• 92% — Fund home and community-based programs for people with disabilities to ensure everyone can access affordable long-term services and supports, regardless of income
• 91% — Impose prices controls on contracts between insurers and healthcare providers
• 91% — Create an affordable state-based health insurance plan that any resident can purchase, regardless of their income or employer coverage status
• 91% — Expand health insurance options so that everyone can afford quality coverage
• 91% — Set standard payments to hospitals for specific procedures
• 91% — Increase reimbursement rates to incentivize health care providers to participate in Medicare
• 91% — Prohibit drug companies form charging more in US than abroad

Support for Action Across Party Lines

There is 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 73% 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 16% cut pills in half or skipped doses of medicine
   due to cost.
2. Fourteen percent (14%) had problems getting mental health care and 8% had problems getting addiction
   treatment.
3. Median household income in New Mexico is $58,722 (2018-2022). U.S. Census, Quick Facts. Retrieved from:
   U.S. Census Bureau QuickFacts, https://www.census.gov/quickfacts/fact/table/NM/BZA210222.
4. Centers for Medicare and Medicaid Services. (2023). Hospital Change of Ownership. Retrieved August 7, 2024,
   from: https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-change-of-
   ownership.
5. A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization. The
   CHOW results in the transfer of the old owner's identification number and provider agreement (including any
   Medicare outstanding debt of the old owner) to the new owner…An acquisition/merger occurs when a currently
   enrolled Medicare provider is purchasing or has been purchased by another enrolled provider. Only the
   purchaser's CMS Certification Number (CCN) and tax identification number remain. Acquisitions/mergers are
   different from CHOWs. In the case of an acquisition/merger, the seller/former owner's CCN dissolves. In a
   CHOW, the seller/former owner's CCN typically remains intact and is transferred to the new owner. A
   consolidation occurs when two or more enrolled Medicare providers consolidate to form a new business entity.
   Consolidations are different from acquisitions/mergers. In an acquisition/merger, two entities combine but the
   CCN and tax identification number (TIN) of the purchasing entity remains intact. In a consolidation, the TINs and
   CCN of the consolidating entities dissolve and a new TIN and CCN are assigned to the new, consolidated entity.
   Source: Missouri Department of Health and Senior Services, Change of Ownership Guidelines—Medicare/State
   Certified Hospice. Retrieved August 23, 2023, from https://health.mo.gov/safety/homecare/pdf/CHOW-
   Guidelines-
   StateLicensedHospice.pdf#:~:text=Acquisitions%2Fmergers%20are%20different%20from%20CHOWs.%20In%2
   0the%20case,providers%20consolidate%20to%20form%20a%20new%20business%20entity.
6. The Source on Healthcare Price and Competition, Merger Review, Retrieved August 7, 2024 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 June 6 to July 8, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,500 respondents who live in New Mexico. 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 1,433 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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