Health care is expensive in the U.S., and Maine is no exception. Nearly three in every four respondents (72%) reported experiencing at least one health care affordability burden in the last year; such as being uninsured due to cost, delaying, or forgoing needed health services entirely due to cost or finding themselves in financial burden to their medical care.

A Range of Health Care Affordability Burdens

In Maine, nearly three quarters (70% of) respondents reported that they, or a family member, skipped or delayed medical care due to cost. Among those reporting affordability challenges, the most common experiences were:

• 31%—Delayed going to the doctor or having a procedure done;
• 30%—Cut pills in half, skipped doses of medicine or did not fill a prescription;¹
• 25%—Skipped a recommended medical test or treatment;
• 22%—Avoided going to the doctor or having a procedure done altogether;
• 17%—Had problems getting mental health care;
• 9%—Skipped or delayed getting a medical assistive device; and
• 4%—Skipped needed maternity or reproductive health care

While cost was the most commonly cited reason for delaying or foregoing care, factors such as the inability to get an appointment (21%) or insurance not covering the service (14%) also contributed to instances of patients delaying or forgoing care. Among uninsured respondents, 45% cited the high cost of insurance as the primary reason they remained without coverage, surpassing other common reasons such as “I don’t need it” and “I don’t know how to get it.” Furthermore (73%) of respondents believe the health care system is unaffordable, and 93% believe health care costs are rising.

Differences in Health Care Affordability Burdens

The frequency and severity of health care affordability burdens may be influenced by an individual’s characteristics, such as their age or income. Survey results from Maine reveal trends in how different populations experience several common affordability burdens; such as affording, primary care visits, surgical procedures, and purchasing medical assistive devices.

Income and Employment

Income is one of the most consistent predictors of an individual’s ability to afford health care. ² Three out of every four respondents (75%) with an annual household income of less than $50,000 reported experiencing at least one health care affordability burden in the last year. Across all income levels, respondents making under $100,000 annually reported delaying or forgoing care due to cost at similar levels (see Figure 1).

Employment also plays a critical role in health care affordability; not only by providing income, but also by providing access to employer-sponsored insurance, which remains the main source of coverage for non-elderly adults in the United States.³ Survey data indicate that part-time workers in Maine may face heightened affordability challenges. Respondents employed part-time reported delaying or forgoing care due to cost more frequently than respondents employed in a full-time position (see Figure 2).

Insurance Coverage and Type

People with different types of insurance navigate the health care system in different ways. For example, people with private insurance may face higher premiums and out-of-pocket costs, while individuals enrolled in Medicaid typically encounter lower direct costs but may face other obstacles, including limited provider networks, restrictions on covered services, and longer wait times for appointments.

Approximately a fifth of Maine’s population (21%) is covered by Medicaid or the Children’s Health Insurance Program (CHIP), which provides subsidized health insurance to people who are low-income or have a disability.⁴ Given its reach, it is not surprising that many respondents expressed support for the program (see Table 1).

However, respondents enrolled in coverage they purchased themselves, such as through the health insurance Marketplace, reported forgoing care more frequently than respondents with other forms of coverage. Respondents enrolled in MaineCare, the state Medicaid program, reported rationing their medication the most. Respondents enrolled in Medicare, coverage for seniors and people with certain disabilities, reported the lowest incidence of rationing medication or going without care due to cost (see Table 2).

When asked, some survey participants also shared personal accounts of being unable to access necessary health care because of the cost. The anecdotes illuminate a common theme: that challenges finding affordable health care exist across all coverage types. Although individuals without health insurance coverage often face the most acute affordability issues, respondents with commercial insurance, Medicare, and Medicaid also shared narratives revealing difficulties accessing care due to cost:

Race and Ethnicity

Overall, respondents of color in Maine reported going without care and rationing medication due to cost more frequently than white, alone non-Hispanic respondents. Eighty-nine percent (89%) of respondents of color reported forgoing care due to cost in the past twelve months, compared to 68% of white alone, non-Hispanic/Latino respondents (see Table 3). White, non-Hispanic respondents reported slightly higher rates of forgoing purchasing a medical assistive device.

Age and Disability

While anyone can be affected by a serious illness or injury, some groups face greater financial obstacles to accessing care. In Maine, young adults aged 25-34 reported the highest rates of forgoing care due to cost. However, affordability concerns extend across age groups, and more than half of all respondents under age 65 reported skipping care in the past year due to financial constraints (see Table 5). Most adults over the age of 65 will be insured under Medicare, which provides affordable coverage for basic health services. However, affordability may remain a concern for this group, particularly for older adults with complex or chronic conditions.

Adults aged 25-34 also reported the highest rates of medication rationing due to cost. This finding has important implications for policymakers interested in improving prescription drug affordability in their state. For example, although the Inflation Reduction Act (IRA) capped insulin costs for Medicare beneficiaries at $35 per month, these protections do not apply to younger populations.⁵ While the survey does not specify which medications were rationed, a non-negligible number of respondents who reported rationing medication due to cost were under the age of 65, highlighting the need for broader efforts to lower out-of-pocket drug costs across all age groups.

Respondents with a disability, or who live with someone with a disability, also reported higher rates of health care affordability burdens. Of those included in this group, 74% reported going without some form of care and 37% 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 (68%) and rationing medication (26%) due to cost (see Table 6).

People with disabilities also face affordability burdens specific to their health needs. For example, 14% of respondents with a disability or with a disabled household member reported delaying the purchase of a medical assistive device (like a wheelchair, cane/walker, hearing aid, or prosthetic limb) due to cost, compared to only 7% of respondents in households without a disabled member. Overall, individuals living with or alongside someone with a disability were more likely to experience at least one health care affordability burden (see Figure 4).

Given that 29% of U.S. adults live with some form of disability, more than a quarter of the population often face elevated health care affordability burdens.⁶ People with a disability pay an average $13,492 annually for health care, while a person without a disability pays $2,853.⁷ Out-of-pocket costs are also more than twice as high for an individual with a disability versus an individual without ($1053 v. $486).⁸

Encountering Medical Debt

Although many respondents reported delaying, forgoing, or rationing care due to cost, others did receive care but faced financial hardship from the resulting medical bills. More than a third of respondents (37%) reported experiencing at least one significant financial burden related to medical debt, including:

• 16%—Were contacted by a collection agency;
• 15%—Used up all or most of their savings to pay off medical bills;
• 12%—Were unable to pay for basic necessities like food, heat or housing due to medical bills;
• 10%—Accumulated large amounts of credit card debt to pay off medical bills;
• 9%—Borrowed money, took out a loan, or another mortgage on their home to pay off medical bills;
• 9%—Were placed on a long-term payment plan to pay off medical bills; and
• 5%—Asked for donations (GoFundMe campaigns) to pay off medical bills.

Respondents of color reported experiencing at least one of the previous financial burden related to medical debt more frequently than white, alone non-Hispanic respondents. Likewise, respondents with a disability or who 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 health insurance they purchased on their own, such as through the Marketplace, reported the highest rates of the above burdens due to medical bills (44%) compared to respondents with all other insurance types (see Table 6).

These findings reflect broader societal challenges. In 2024, nearly 100 million Americans collectively owed more than $220 billion in medical debt.⁹ Even with insurance, many Americans struggle to afford medical bills. With the average cost of a one-night hospital stay in the U.S. exceeding $3,000, most consumers are unable to afford the cost of a sudden illness or injury.¹⁰ The majority of respondents (72%) reported that they were insured at the time they incurred their medical debt. When asked to describe why they still incurred medical debt despite having health insurance coverage, the most common responses were:

• 19%—My insurance didn’t cover the service at all;
• 56%—My insurance only covered a portion of the service, and the remaining bill is too high;
• 14%—My deductible was too high, and I was not able meet it;
• 2%—My coinsurance was too high, and I could not afford to pay it; and
• 2%—The interest rate on the debt is too high

High Levels of Worry about Affording Care and Coverage

The majority of Maine respondents are concerned about their ability to afford care. In total, 82% of respondents reported being either “worried” or “very worried” about affording some aspect of care in the future. The most commonly cited concerns include:

• 69%—Being unable to afford nursing home or home care services;
• 63%—Being unable to afford medical costs when elderly;
• 61%—Affording care in the event of a serious illness or accident;
• 53%—Health insurance will become too expensive;
• 50%—Affording the cost of prescription drugs; and
• 26%—Being unable to afford the cost of maternity and reproductive care.

While two of the most frequently cited concerns, affording the cost of nursing home or home care services and affording medical costs when elderly, are typically associated with older adults, these worries were more frequently reported by younger respondents. For example, 71% of respondents aged 35–44 and 70% of those aged 25–34 expressed concern about being able to afford medical costs when they are older. More than half of all respondents under age 65 reported being worried about paying for some form of long-term care (see Figure 5).

The annual cost of long-term care in the U.S. ranges from $70,800 for assisted living to over $127,000 for a private room in a nursing facility.¹¹ Although insurance can offset some of these costs, many plans (including Medicare) only cover long-term care in specific circumstances.¹² As a result, paying out-of-pocket for care may be financially unfeasible for most families, and Medicaid remains the primary payer for nursing home and intermediate care facility services in the absence of a better option.¹³

In addition to age, concerns about affordability were also cited across all other demographic groups. However, certain groups expressed concern more frequently than others, including respondents living in a household that earns less than $50,000 a year, those with a disability or who live with a person with a disability (see Table 7). Overall, 54% of respondents with an annual household income between $50,000 and $75,000 reported worrying about affording health insurance in the past year. However, 46% of those earning over $100,000 per year also reported concerns (see Table 7).¹⁴

Concerns about paying for specific types of care also were reported, many respondents worried about affording and maintaining health insurance coverage. Overall, 33% of all respondents reported that they were concerned about losing their health insurance coverage, and 53% reported that they were concerned about affording their health insurance coverage. Worry about the cost of insurance was more common than concern about losing coverage, and this pattern held true across all income levels, racial and ethnic groups, and types of coverage (see Table 7).

Finally, in the past year, 32% of respondents reported that they were aware of a merger or acquisition in their community.¹⁵ Among those who said they noticed changes following the merger or acquisition, most reported:

• 30%—I have fewer choices of providers;
• 17%—I have experienced lower quality care; and
• 15%—I have to pay more for my care.

When asked about their largest concern related to health care consolidation, respondents most frequently reported:

• 27%—I’m concerned I will have fewer choices of where to receive care;
• 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;
• 16%—I’m concerned my doctor may no longer be covered by my insurance; and
• 14%I’m concerned I will have to travel farther to see my doctor

Respondent Perceptions of the Health System, Policy Solutions

In light of Maine respondents’ health care affordability burdens and concerns, it is not surprising that they are dissatisfied with the health system. Of the respondents surveyed, 89% agreed or strongly agreed that “the system needs to change.”

To investigate further, the survey asked respondents to share their perspectives on governmental actions to address the high health costs.

Government Actions

Maine 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:

• 68%—Health care
• 50%—Affordable Housing
• 45%—Economy/Joblessness

Maine respondents most frequently reported believing that the responsibility for high health care costs lies with industry stakeholders, such as:

• 81%—Drug companies charging too much money;
• 77%—Insurance companies charging too much money; and
• 54%—Hospitals charging too much money

Support for Policy Solutions

There is support for change regardless of respondents’ political affiliation (see Table 8). 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. When it comes to tackling costs, respondents endorsed a number of strategies, including: