Data Brief | No. 15 | October 2018

Pennsylvania Residents 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 Pennsylvania. The survey of more than 960 Pennsylvania adults, conducted from Aug. 28-Sept. 14, 2018, found that: 

  • 1 in 2 Pennsylvania adults experienced healthcare affordability burdens in the past year,  including 1 in 3 who struggled to pay medical bills.
  • 4 in 5 are worried about affording healthcare in the future. 
  • Not surprisingly, a very similar number agreed that the system needs to change. Across party lines, 4 of 5 residents expressed dissatisfaction with the current health system. 
  • Also across party lines, 9 of 10 supported a broad array of solutions. 

A Range of Healthcare Affordability Burdens

Like many Americans, Pennsylvania residents currently experience hardship due to high healthcare costs. All told, 51% of Pennsylvania adults experienced one or more of the following healthcare affordability burdens in the prior 12 months. 

Being Uninsured Due to High Premium Costs 

74% of uninsured adults cited “too expensive” as the major reason for not having coverage, far exceeding reasons like “don’t need it,” “don’t know how to get it” and other reasons.

Delaying or Foregoing Healthcare Due to Cost

Two out of five (41%) Pennsylvania adults who needed healthcare during the year encountered one or more cost related barriers to getting that care. In descending order of frequency, they reported:

  • 29%—Delayed going to the doctor or having a procedure done 
  • 25%—Avoided going altogether to the doctor or having a procedure done 
  • 24%—Skipped a recommended medical test or treatment 
  • 19%—Did not fill a prescription 
  • 17%—Cut pills in half or skipped doses of medicine
  • 11%—Had problems getting mental healthcare 

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 bills, dental bills and prescription drugs, likely reflecting the frequency with which Pennsylvania adults seek these services—or, in the case of dental, lower rates of coverage for these services. 

Struggling to Pay Medical Bills  

One-third (32%)of Pennsylvania adults experienced one or more of these struggles to pay medical bills: 

  • 15%—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
  • 8%—Racked up large amounts of credit card debt
  • 7%—Borrowed money or got a loan or another mortgage on their home
  • 6%—Placed on a long-term payment plan

High Levels of Worry About Affording Healthcare in the Future

Pennsylvania adults worry about affording healthcare in the future in numbers that exceed the number currently experiencing a healthcare affordability burden. Overall, more than four out of five (83%) reported being “worried” or “very worried” about affording some aspect of healthcare, including:

  • 71%—Won’t be able to afford nursing home and home care services 
  • 70%—Won’t be able to afford medical costs when elderly 
  • 70%—Cost of a serious illness or accident 
  • 67%—Prescription drug costs 

In addition, respondents were “worried” or “very worried” about not being able to afford health insurance in the future (68%). The greatest concern was among those who buy private health coverage or have Medicaid—nearly three quarters of adults were worried (Figure 1). In addition, more than half of Medicaid recipients were worried about losing their coverage.


Regional Differences in Healthcare Affordability Burdens

The survey also revealed regional differences in how Pennsylvanians experience healthcare affordability burdens (Figure 2).  

The Southwest region reported the greatest rate of healthcare affordability burdens—58% of adults had one or more of the three types of burdens described above. In contrast, the South Central and Lehigh Valley region showed the fewest affordability burdens, although still high, affecting nearly half (47%) of adults (Figure 3). The number of survey responses in the Northwest region were insufficient to produce reliable estimates for that region.

Perhaps reflecting these high rates of healthcare affordability burdens, residents of Southwest Pennsylvania also reported starkly higher levels for specific healthcare worries: 

  • Worry about affording medical costs when elderly spiked at 78% for the Southwest region, compared to 66% for the Southeast region.
  • Worry about affording the costs of serious illness or accident spiked at 71% for the Southwest region, compared to 64% for the Northeast and North Central region. 

But overall levels of worry about any healthcare burden was high across regions—80% or higher. Regional reports available at



Dissatisfaction with the Health System 

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

  • Just 25% agreed or strongly agreed with the statement “We have a great healthcare system in the U.S.,”
  • while 78% agreed or strongly agreed “the system needs to change. 

Of more than 20 options, the options cited most frequently as being a “major reason” for high healthcare costs were:

  • 76%—Drug companies charging too much money 
  • 72%—Insurance companies charging too much money 
  • 70%—Hospitals charging too much money 
  • 57%—Some well-known or large hospitals or doctor groups using their influence to get higher payments from insurance companies 

High Support for Many Specific Fixes to Health System

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

  • 93%—Make it easy to switch insurers if a health plan drops your doctor
  • 92%—Show what a fair price would be for specific procedures
  • 91%—Require insurers to provide upfront cost estimates to consumers 
  • 91%—Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes 

While Pennsylvania residents are united in calling for a role for government in addressing high healthcare costs, they also see a role for themselves: 

  • 80%—Would switch from a brand to a generic if given the option 
  • 60%—Reported that taking better care of their personal health is one of the top three actions that would be most effective in addressing affordability. 
  • 49%—Have tried to find out the cost of a drug beforehand 

Support for Change Across Party Lines

What is remarkable about the findings is high support for change regardless of the respondent’s political affiliation (Table 1). For example, 90% think the government should require drug companies to provide advanced notice of price increases and information to justify those increases, including 88% of Republicans and 92% of Democrats.

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 need a top priority. Annual surveys can help assess whether or not 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. Regional reports are available at

The survey used a web panel from SSI Research Now with a demographically balanced sample of approximately 1,000 respondents who live in Pennsylvania. 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 969 cases for analysis with weighting occurring in age, gender and income to be demographically representative of Pennsylvania. After those exclusions, the demographic composition of respondents can be found in the table below.