Data Brief | No. 20 | February 2019

Utah 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 Utah.

A survey of more than 1,000 Utah adults conducted from August 28 to September 14, 2018, found that: 

• More than half experienced healthcare affordability burdens in the past year;
• Even more are worried about affording healthcare in the future; and
• Across party lines, they express strong support for policymakers to address these problems. 

A Range of Healthcare Affordability Burdens

Like many Americans, Utah residents currently experience hardship due to high healthcare costs.  All told, 60% of Utah adults experienced one or more of the following healthcare affordability burdens in the prior 12 months. 

1.) Being Uninsured Due to High Premium Costs 

58% 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. 

2.) Delaying or Foregoing Healthcare Due to Cost

More than half (53%) of Utah 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:

• 41%—Delayed going to the doctor or having a procedure done 
• 34%—Avoided going to the doctor or having a procedure done 
• 30%—Skipped a recommended medical test or treatment 
• 24%—Did not fill a prescription 
• 19%—Cut pills in half or skipped doses of medicine
• 17%—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 Utah adults seek these services—or, in the case of dental, lower rates of coverage for these services. 

3.) Struggling to Pay Medical Bills  

One-third (33%) of Utah adults experienced one or more of these struggles to pay their medical bill: 

• 17%—used up all or most of their savings
• 11%—contacted by a collection agency
• 10%—unable to pay for basic necessities like food, heat, or housing
• 10%—racked up large amounts of credit card debt
• 10%—placed on a long-term payment plan
• 9%—borrowed money or got a loan or another mortgage on their home

High Levels of Worry About Affording Healthcare in the Future

Utah 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 (85%) reported being “worried” or “very worried” about affording some aspect of healthcare, including:

• 70%—Won’t be able to afford nursing home and home care services
• 69%—Cost of a serious illness or accident
• 68%—Won’t be able to afford medical costs when elderly
• 54%—Prescription drug costs

In addition, respondents were “worried” or “very worried” about not being able to afford health insurance in the future (69%). The greatest concern was among those that buy private health coverage or have Medicaid—almost three quarters of adults were worried (see Figure 1). In addition, more than half of Medicaid recipients were worried about losing their coverage.

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Income Differences in Healthcare Affordability Burdens

Families with household incomes of less than $50,000 reported starkly higher levels of healthcare affordability burdens (see Figure 2) and worry (see Table 1). Surprisingly, the data also show affordability burdens and worry affect families quite far up the income ladder. As a reminder, median household income in Utah was $65,977 in 2016.¹ 

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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 Utah residents were extremely dissatisfied with the health system. Statewide: 

Just 26% agreed or strongly agreed with the statement “We have a great healthcare system in the U.S.,”

While 77% 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:

• 79%—Drug companies charging too much money 
• 68%—Hospitals charging too much money 
• 65%—Insurance companies charging too much money 
• 57%—Some well-known or large hospitals or doctor groups using their influence to get higher payments from insurance companies 

When it comes to tackling health costs and other fixes, respondents endorsed a number of strategies, including these top vote getters: 

• 93%—Show what a fair price would be for specific procedures
• 93%—Require insurers to provide upfront cost estimates to consumers
• 92%—Make it easy to switch insurers if a health plan drops your doctor
• 92%—Require hospitals and doctors to provide up front patient cost estimates

What is remarkable about the findings is high support for change regardless of the respondent’s political affiliation (see Table 2).

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

• 90% would switch from a brand to a generic if given the option 
• 62% reported that taking better care of their personal health is one of the top three actions that would be most effective in addressing affordability. 
• 57% have tried to find out the cost of a drug beforehand 

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. 

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 SSI Research Now containing a demographically balanced sample of approximately 1,000 respondents who live in Utah. 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 1,080 cases for analysis with weighting occurring in age, gender and income to be demographically representative of Utah. After those exclusions, the demographic composition of respondents in found in the table below.

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