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; 
• Over 2 in 3 (67%) of all respondents delayed or went without health care due to cost in the last twelve months; 
• Low-income respondents and respondents with a disability or living in a household with a person with a disability reported 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, Ohio adults experience hardship due to high health care costs. In the past twelve months, nearly seven out of ten (69%) respondents experienced at least one of the following health care affordability burdens: 

1) BEING UNINSURED DUE TO HIGH COSTS 

Greater than half (55%) 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, 53% of respondents without dental insurance and 43% 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 

Well over half (67%) of all respondents reported delaying or going without health care during the prior 12 months due to cost:  

• 26%—Delayed going to the doctor or having a procedure done 
• 26%—Cut pills in half, skipped doses of medicine or did not fill a prescription¹ 
• 24%—Skipped needed dental care 
• 21%—Skipped a recommended medical test or treatment 
• 14%—Avoided going to the doctor or having a procedure done altogether 
• 14%—Skipped needed vision services 
• 13%—Had problems getting mental health care or addiction treatment² 
• 6%—Skipped needed hearing services 
• 5%—Skipped or delayed getting a medical assistive device 

Ohio respondents most frequently cited cost as the reason that they or their family members did not receive care services in the past year (21%), followed by not being able to get an appointment (16%), and not having insurance (13%). These causes were reported more often than 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 one-third (36%) of respondents reported experiencing one or more of these struggles to pay their medical bills: 

• 13%—Used up all or most of their savings  
• 13%—Were contacted by a collection agency 
• 11%—Were unable to pay for basic necessities like food, heat or housing 
• 9%—Borrowed money, got a loan or another mortgage on their home 
• 8%—Racked up large amounts of credit card debt  
• 8%—Were placed on a long-term payment plan 
• 5% – Asked for donations (GoFundMe campaigns) 

HIGH LEVELS OF WORRY ABOUT AFFORDING HEALTH CARE IN THE FUTURE 

Ohio respondents also exhibit high levels of worry about affording health care in the future. Four in five (80%) reported being “worried” or “very worried” about affording some aspect of health care in the future, including: 

• 65% — Cost of nursing home or home care services 
• 62% — Medical costs when elderly 
• 61% — Health insurance will become unaffordable 
• 59% — Medical costs in the event of a serious illness or accident 
• 53%— Prescription drugs will become unaffordable 
• 50% — Cost of dental care 
• 45% — Cost of needed vision services 
• 41% — 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 younger respondents. More than two in every three respondents between the age of 25 and 34 (68%) and 74% of respondents aged 45-54 reported being worried about affording medical care when elderly. Additionally, at least 60% of all respondents under the age of 65 reported being concerned about affording nursing home or home care costs. This suggests that Ohio respondents may be worried about affording the cost of care for both aging relatives and themselves.  

Likewise, worry about affording health care was highest among respondents living in low-income households, those with a disabled household member, and those in the Southwest Ohio area (see Table 1). Overall, 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, 75% 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. 

Respondents reported concerns that health insurance will become 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 respondents living in Southwest Ohio, Hispanic or Latino respondents, and respondents that purchase their coverage independently, such as through the health insurance marketplace (see Figure 1). 

Although concerns about affording coverage surpassed fears about losing coverage, certain respondents were more concerned about losing their health insurance coverage than others. Concerns about losing health insurance coverage were most prevalent among respondents enrolled in Ohio Medicaid, respondents living in Southwest and Eastern Ohio, and respondents that purchase their coverage independently, such as through the health insurance marketplace (see Table 2). 

DIFFERENCES IN HEALTHCARE AFFORDABILITY BURDENS

The survey also revealed differences in how Ohio 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. Nearly four out of five (79%) respondents earning less than $50,000 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 this income group reporting higher rates of postponing or going without care due to cost (see Figure 3).

Further analysis found that Ohio respondents aged 18-24 reported the highest rates of forgoing care due to cost. However, at least half of all respondents under the age of 65 reported going without care due to financial barriers, signaling that the issue extends across age groups (see Figure 4).  

DISABILITY

Respondents with a disability or living in a household with a person with a disability reported the highest rates forgoing care and rationing medication due to cost. Of those included in this group, 81% reported going without some form of care and 35% 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 (61%) and rationing medication (22%) due to cost (see Table 4).

These respondents also more frequently reported skipping necessary mental health, addiction treatment, vision and dental care services due to cost compared to respondents living in households without a person with a disability (see Table 3). People with disabilities face health care affordability burdens unique to their disabilities— 11% of respondents with a disability or 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 3% of respondents in households without a disabled person reported this experience.

INSURANCE 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 or Medicare generally have lower costs but may encounter limited provider options, greater restrictions around covered services, and longer wait times for services.

In Ohio, respondents enrolled in Medicaid reported going without care due to cost more frequently than respondents enrolled in other coverage types. Respondents with coverage they purchased on their own, such as through the health insurance Marketplace, reported rationing their medication the most (see Table 4). 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.

RACE AND ETHNICITY

Overall, respondents of color in Ohio reported going without care and rationing medication due to cost more frequently than white respondents. In Ohio, eighty-one percent (81%) of respondents of color reported going without care due to cost in the past twelve months compared to 63% of white alone, non-Hispanic/Latino respondents (see Table 4). However, further analysis showed that respondents that are white alone, not Hispanic, reported slightly higher rates of skipping dental services and challenges receiving mental health care, while respondents of color reported going without other types of care at the same at an elevated rate relative to white respondents (see Figure 5). Postponing care and rationing medication often negatively impacts health status, demonstrating the importance of minimizing cost-related barriers to care in efforts to alleviate health disparities.

The high cost of health care impacts everyone. Respondents asked to describe a time that they were unable to get health care due to cost to illuminate the various ways that these barriers can manifest (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.

ENCOUNTERING MEDICAL DEBT

In the absence of affordable care options, individuals may find themselves burdened by medical costs. 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 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 Medicaid coverage reported the highest rates of the above burdens due to medical bills (48%) compared to respondents with all other insurance types (see Table 6).

IMPACT OF AND WORRY RELATED TO HOSPITAL CONSOLIDATION*

In addition to the above health care affordability burdens, a small share of Ohio respondents reported being negatively impacted by health system consolidation. From 2017 to 2023, there were five changes in ownership (CHOW) involving Ohio hospitals through mergers, acquisitions, or another CHOW.^4,5

Ohio requires that the State Attorney General be notified of nonprofit hospital transactions, and grants authority to approve or deny transactions.⁶ However, for the first five years following the transaction, the state does require nonprofit hospitals to provide annual reports indicating that the change in ownership has not negatively impacted access to health services in the affected communities.

In the past year, 22% of respondents reported that they were aware of a merger or acquisition in their community. Nearly a quarter (22%) of those respondents reported that they or a family member were unable to access their preferred health care organization because of barriers arising due to the merger, such as the change made their preferred organization out-of-network.

Among those who reported losing access their preferred health care provider due to a merger:

• 36% skipped filling a prescription medication;
• 35% changed their preferred doctor or hospital to one that is in-network;
• 33% skipped one or more recommended follow-up appointment(s) due to a merger;
• 30% 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; and
• 9% had to change their preferred provider due to a merger resulting in a service closure.

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

• 42% reported that the merger created an added wait time when searching for a new provider;
• 18% reported that the merger created a gap in the continuity of my care; and
• 15% reported that the merger created an added financial burden

While a smaller portion of respondents reported being unable to access their preferred health care organization because of a merger, far more respondents (53%) 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:

• 29% — I’m concerned I will have fewer choices of where to receive care
• 25% — I’m concerned my doctor may no longer be covered by my insurance
• 22% — I’m concerned I will have to pay more to see my doctor
• 10% — I’m concerned I will have a lower quality of care
• 8% — I’m concerned I will have to travel farther to see my doctor

*Note: The sample size of respondents who said they were affected by a closure was not large enough to report reliable estimates, so the values in this section should be interpreted with caution.

DISSATISFACTION WITH THE HEALTH SYSTEM AND SUPPORT FOR CHANGE

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

• Just 35% agreed or strongly agreed that “we have a great healthcare system in the U.S.,”
• While 73% agreed or strongly agreed that “the 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 ACTIONS

Ohio respondents see a role for themselves in addressing health care affordability. When asked about specific actions they could take:

• 53% of respondents reported researching the cost of a drug beforehand, and
• 80% 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: 

• 72% — Take better care of my personal health 
• 41% — Research treatments myself before going to the doctor 
• 34% — Do more to compare provider cost and quality before getting services 
• 26% — There is nothing I can do personally to make our health system better
• 24% — Contact my state representatives asking them to address high healthcare prices and lack of affordable coverage options

GOVERNMENT ACTIONS

Ohio 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:

• 50% — Economy/Joblessness
• 43% — Health care
• 38% — Affordable Housing

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

• 49% — Address high health care costs, including prescription drugs
• 36% — Improve Medicare, coverage for seniors and those with serious disabilities
• 35% — Preserve consumer protections preventing people from being denied coverage or charged more for having a pre-existing medical condition
• 33% — Get health insurance to those who cannot afford coverage

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

• 76% — Drug companies charging too much money
• 71% — Insurance companies charging too much money
• 67% — Hospitals charging too much money

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

• 94% — The government should exhibit what a fair price would be for specific procedures
• 92% — Require drug companies to provide notice of price increases and to justify those increases
• 92% — Require insurers to provide up-front cost estimates to consumers 
• 92% — Make it easier to switch insurers if your health plan stops covering your provider
• 91% — Require hospitals and doctors to provide upfront patient cost estimates
• 91% — Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes
• 90% ­— Cap out-of-pocket costs for life-saving medications, such as insulin

SUPPORT FOR ACTION ACROSS PARTY LINES

There is remarkable 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.  

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.