KEY FINDINGS

A survey of more than 1, 600 Ohio adults, conducted from September 26 to October 14, 2024, found:

• Over 2 in 3 (69%) experienced at least one health care affordability burden in the past year;
• 4 in 5 (80%) worry about affording health care in the future;
• Respondents living in households with a person with a disability more frequently reported rationing medication due to cost compared to respondents living in households without a person with a disability (35% versus 22%); delaying or going without care due to cost (81% versus 61%); and experiencing a cost burden due to medical bills (55% versus 28%).
• Thirty-two percent of respondents of color skipped needed medical care due to distrust of or feeling disrespected by health care providers, compared to 15% of white alone, non-Hispanic respondents; and
• Fifty-seven percent of all respondents think that people are treated unfairly based on their race or ethnic background somewhat or very often in the U.S. health care system.

DIFFERENCES IN AFFORDABILITY BURDENS & CONCERNS

RACE AND ETHNICITY

Health disparities and a lack of affordable care negatively impact many communities of color, particularly Black, Hispanic and Latino communities.^1,2 Ohio respondents of color reported higher rates of many affordability burdens when compared to white alone, non-Hispanic/Latino respondents, including cost burdens due to medical bills (see Table 1).³

A small share of respondents also reported barriers to care that were unique to their ethnic or cultural backgrounds. Thirty-one (3% of) respondents reported not getting needed medical care because they couldn’t find a doctor of the same race, ethnicity or cultural background as them and 18 (1% of) respondents reported not getting needed care because they couldn’t find a doctor who spoke their language.

INCOME AND EDUCATION

The survey also highlighted differences in health care affordability burdens between different income and educational levels. Respondents living in households earning below $50,000 per year most frequently reported experiencing an affordability burden, with 79% struggling to afford health care in the past twelve months (see Table 2). Additionally, 30% of respondents with an annual household income of $50,000 or less reported not filling a prescription, skipping doses, or cutting pills in half due to cost.

These respondents also more frequently reported experiencing a cost burden due to medical bills, such as incurring medical debt, depleting savings or sacrificing basic needs like food, heat, or housing compared to those earning $100,000 or more annually (43% versus 31%). Still, over half of respondents living in higher income households also faced affordability issues, indicating that these burdens affect all income groups. At least 75% of respondents across all income levels expressed concern about affording health care now or in the future.

Similarly, Ohio respondents with a Bachelor’s or graduate degree reported experiencing a health care affordability burden less frequently than respondents with lower educational attainment. In contrast, respondents who did not pursue additional education beyond a high school diploma or GED reported experiencing a health care affordability burden (76%), and a health care cost burden due to medical bills (42%) more frequently than other respondents (see Table 3).

The relationship between education and income is well established, however higher education is also associated with better health outcomes, lower morbidity and greater health care affordability.⁴ This disparity is influenced by various mediators such as economic status and the likelihood of being employed in a position which offers employee benefits including paid time off, sick leave and health insurance, which are associated with greater utilization of preventive health care.⁵

DISABILITY STATUS

People with disabilities interact with the health care system more often than those without disabilities, which frequently results in greater out-of-pocket costs.⁶ Additionally, individuals who receive disability benefits face unique coverage challenges that impact their ability to afford care, such as losing coverage if their income or assets exceed certain limits (e.g., after marriage).⁷

In Ohio, respondents with disabilities or respondents who live with someone with a disability reported more frequent affordability burdens compared to others (see Table 4). These respondents also reported greater worries about health care affordability in general compared to respondents without a disability or who do not live with a person with a disability (89% versus 76%) and losing health insurance compared to respondents without a disability or who do not live with a person with a disability (46% versus 24%).

Eleven percent (11%) of respondents with a disability or who live with a person with a disability also reported that they or their household member delayed getting a medical assistive device such as a wheelchair, cane, walker, hearing aid or prosthetic limb due to cost, compared to only 3% of respondents without a disability who may have required one of these tools for temporary support (see Figure 2). Additionally, 17% of respondents with a disability in their household reported problems accessing mental health care, compared to 6% of those without a disability.

GENDER AND SEXUAL ORIENTATION

The survey revealed notable differences in health care affordability burdens and concerns based on gender and sexual orientation. Women reported higher rates of experiencing at least one affordability burden in the past year compared to men (70% versus 68%) (see Table 5). They also more frequently reported delaying or forgoing care due to cost and reported higher rates of rationing medications by not filling prescriptions, skipping doses, or cutting pills in half. Although many respondents expressed concerns about health care costs, a higher percentage of women reported being worried about affording some aspect of coverage or care compared to men (83% versus 77%), although a slightly higher percentage of men reported experiencing a cost burden due to medical bills (36% versus 37%).

The survey also revealed that LGBTQIA+ respondents more frequently experienced affordability burdens, with 33% reporting rationing medication due to cost compared to 25% of other respondents (see Table 6). Members of the LGBTQIA2S+ community may encounter unique challenges accessing health care and medications, including limited insurance coverage and discrimination within the health care system.^8,9 State and federal policies, particularly regarding gender-affirming treatments, can further hinder access or limit coverage, exacerbating financial strain and health disparities.¹⁰  Unfortunately, due to the small sample size, this survey could not produce reliable estimates exclusively for transgender, genderqueer or nonbinary respondents.

DISTRUST AND MISTRUST IN THE HEALTH SYSTEM

Whether a patient trusts or feels respected by their health care provider may influence their willingness to seek necessary care. In Ohio, more than a quarter (28%) of respondents reported feeling that their health care providers never, rarely or only sometimes treat them with respect.

When asked why they felt that health care providers did not treat them with respect, respondents most frequently cited income or financial status (48%), disability (24%), race (24%), gender or gender identity (16%), ethnic background (14%) and educational attainment (19%). In lesser numbers, some respondents also cited sexual orientation (10%), experience with violence or abuse (9%) and religion (5%) as the primary reason.

When asked to describe how their identities or circumstances have impacted their ability to access affordable health care, respondents offered examples of how they perceived their race, income, insurance status, gender and ethnicity to impact their health care (see Table 7).

The survey also revealed differences in the frequency of respondents who reported forgoing care because they distrusted or felt disrespected by their health care provider by coverage type, income, educational attainment, gender identity, orientation, disability, race and ethnicity. For instance, 27% of respondents enrolled in the Ohio Medicaid program reported going without care due to distrust or perceived disrespect, compared to only 20% of individuals with employer-sponsored insurance (see Table 8).

INDIVIDUAL & SYSTEMIC RACISM

Respondents believe that both individual and systemic racism exist in the U.S. health care system. Fifty-seven percent reported that they believe that people are treated unfairly by the health care system due to their race or ethnicity either somewhat or very often. When asked what they think causes health care systems to treat people unfairly, respondents most frequently responded with the following:

• 15% cited policies and practices built into the health care system;
• 16% cited the actions and beliefs of individual health care providers; and
• Greater than two in five (43%) believe it is an equal mixture of both.

DISATISFACTION WITH THE HEALTH SYSTEM AND SUPPORT FOR CHANGE

Given this information, it is not surprising that 73% of Ohio respondents agree or strongly agree that the U.S. health care system needs to change. Recognizing how the health care system disproportionately harms some groups of people over others is key to creating a fairer and higher value system for all. 

Making health care affordable for all residents is an area ripe for policymaker intervention, with widespread support for government-led solutions across party lines. For more information on the types of strategies Ohio residents want their policymakers to pursue, see: Ohio Residents Struggle to Afford High Health Care Costs; Worry about Affording Health Care in the Future; Support Government Action across Party Lines, Healthcare Value Hub, Data Brief (December 2024).  

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 September 26 to October 14, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,700 respondents who live in Ohio. 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 1,670 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.