Healthcare is expensive in the U.S., and Oklahoma is no exception. Nearly three in every four respondents (72%) reported experiencing at least one healthcare affordability burden in the last year; such as being uninsured due to cost, delaying, or skipping needed care, or facing financial hardship from medical expenses.

Across all insurance types—employer coverage, individual plans, Medicare, and Medicaid—respondents shared concerns about difficulty accessing care due to cost.

Most Oklahoma respondents expressed support for government efforts to make price and quality information more accessible and to help consumers navigate hospital care. At the same time, they emphasized wanting clarity on how these policies might affect what they pay. More than 80% agreed that lawmakers should disclose how proposed laws and mandates impact costs for consumers, taxpayers, and businesses. Less than half (42%) agreed that lawmakers should require insurers to cover more services if it increases premiums for everyone.

The largest share of respondents (74%) identified drug companies as the primary driver of high healthcare costs. Most said the government should limit the price of expensive prescription drugs (90%) and take action to rein in drug prices overall (91%). Only 31% felt state lawmakers should support local pharmacies if it results in higher prescription drug costs for everyone.

A Range of Healthcare Affordability Burdens

In Oklahoma, over two in three (68% of) respondents reported that they, or a family member, skipped or delayed medical care due to cost. Among those reporting  challenges due to cost, the most common experiences were:

• 31%—Delayed going to the doctor or having a procedure done;
• 31%—Cut pills in half, skipped doses of medicine or did not fill a prescription;¹
• 24%—Skipped a recommended medical test or treatment;
• 23%—Avoided going to the doctor or having a procedure done altogether;
• 12%—Had problems getting mental healthcare;
• 9%—Skipped or delayed getting a medical assistive device; and
• 3%—Skipped needed maternity or reproductive healthcare.

While cost was the most commonly cited reason for delaying or foregoing care, factors such as the inability to get an appointment (11%) or not having insurance that covered the service (13%) also contributed to instances of patients delaying or forgoing care. Among uninsured respondents, 52% 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 (67%) of respondents believe the healthcare system is unaffordable, and 92% believe healthcare costs are rising.

Differences in Healthcare Affordability Burdens

The frequency and severity of healthcare affordability burdens may be influenced by an individual’s characteristics, such as their age or income. Survey results from Oklahoma 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 healthcare. ³ Over four out of every five respondents (83%) with an annual household income of less than $50,000 reported experiencing at least one healthcare affordability burden in the last year. These respondents also reported delaying or forgoing care due to cost more frequently than respondents with higher incomes (see Figure 1).

Employment also plays a critical role in healthcare 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 U.S.⁴ Survey data indicate that unemployed workers in Oklahoma may face heightened affordability challenges. Respondents who were unemployed, but seeking employment reported delaying or forgoing care due to cost and rationing medication due to cost more frequently than respondents employed in a full-time or part-time position (see Figure 2).

Insurance Coverage and Type

People with different types of insurance navigate the healthcare system in different ways. For example, people with private insurance may pay higher premiums and out-of-pocket costs, than those with government-sponsored insurance. 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.

However, respondents enrolled in SoonerCare, the state Medicaid program, reported forgoing care more frequently than respondents with other forms of coverage. These respondents also 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 healthcare because of the cost. The anecdotes illuminate a common theme: that challenges finding affordable healthcare exist across all coverage types. Although individuals without health insurance coverage often face the most acute affordability issues, respondents with insurance through their employer, insurance they have purchased on their own, Medicare, and Medicaid also shared narratives revealing difficulties accessing care due to cost:

Race and Ethnicity

Overall, respondents of color in Oklahoma reported going without care and rationing medication due to cost more frequently than white, non-Hispanic respondents. Seventy-eight percent (78%) of respondents of color reported forgoing care due to cost in the past twelve months, compared to 63% of white, non-Hispanic/Latino respondents (see Table 3). White, non-Hispanic respondents reported slightly higher rates of delaying going to the doctor or having a procedure done. However, respondents of color reported other healthcare affordability burdens, like forgoing needed health services entirely due to cost, at the same or at an elevated rate relative to white, non- Hispanic respondents (see Figure 3).

Age and Disability

In Oklahoma, young adults aged 25-34 reported the highest rates of forgoing care due to cost. However, affordability concerns extend across age groups—more than half of all respondents under age 55 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 35-44 reported the highest rates of medication rationing due to cost (37%), closely followed by young adults ages 18-24 and 25-34 (both 36%).  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.⁶ 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.

In the U.S., 29% of adults live with some form of disability, more than a quarter of the population often face elevated healthcare affordability burdens.⁷ People with a disability pay an average $13,492 annually for healthcare, while a person without a disability pays $2,853.⁸ Out-of-pocket costs are also more than twice as high for an individual with a disability versus an individual without ($1053 v. $486).⁹

In Oklahoma, respondents with a disability, or who live with someone with a disability, also reported higher rates of healthcare affordability burdens. Of those included in this group, 76% reported going without some form of care and 43% 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 (65%) and rationing medication (26%) due to cost (see Table 6).

People with disabilities also face affordability burdens specific to their health needs. For example, 16% of respondents with a disability or with a household member with a disability 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 6% of respondents in households without a household member with a disability. Overall, individuals living with or alongside someone with a disability were more likely to experience at least one healthcare affordability burden (see Figure 4).

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 (39%) reported experiencing at least one significant financial burden related to medical debt, including:

• 17%—Were contacted by a collection agency;
• 14%—Used up all or most of their savings to pay off medical bills;
• 14%—Were unable to pay for basic necessities like food, heat or housing due to medical bills;
• 10%—Borrowed money, took out a loan, or another mortgage on their home to pay off medical bills;
• 8%—Accumulated large amounts of credit card debt to pay off medical bills;
• 8%—Were placed on a long-term payment plan to pay off medical bills; and
• 4%—Asked for donations (GoFundMe campaigns) to pay off medical bills.

Respondents of color reported experiencing at least one of the previous financial burdens related to medical debt more frequently than white, 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 SoonerCare, the state Medicaid program, reported the highest rates of the above burdens due to medical bills (50%) 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.¹⁰ 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.¹¹ The majority of respondents (73%) 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:

• 60%—My insurance only covered a portion of the service, and the remaining bill is too high;
• 16%—My insurance didn’t cover the service at all; and
• 11%—My deductible was too high, and I was not able meet it.

High Levels of Worry about Affording Care and Coverage

The majority of Oklahoma respondents are concerned about their ability to afford care. In total, 75% of respondents reported being either “worried” or “very worried” about affording some aspect of care in the future. The most commonly cited concerns include:

• 58%—Being unable to afford nursing home or home care services;
• 56%—Being unable to afford medical costs when elderly;
• 55%—Affording care in the event of a serious illness or accident;
• 51%—Affording the bill from an ambulance ride in an emergency;
• 50%—Being denied insurance coverage for a service you need; and
• 48%—Affording health insurance as it becomes too expensive.

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 are frequently reported by younger respondents. For example, 54% of respondents aged 18–24 and 56% 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 (73%) 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.¹⁶ Although insurance can offset some of these costs, many plans—including Medicare—only cover long-term care in specific circumstances.¹⁷ 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.^18,19

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, and those who were unemployed (see Table 7). Overall, 61% of respondents with an annual household income less than $50,000 reported worrying about affording some aspect of coverage or care in the past year. Thirty-three percent of those earning over $100,000 per year also reported concerns (see Table 7).²⁰

Concerns about paying for specific types of care also were reported, as many respondents worried about affording and maintaining health insurance coverage. Overall, 30% of all respondents reported that they were concerned about losing their health insurance coverage, and 48% reported that they were concerned about affording their health insurance coverage. Like affordability, respondents of color expressed concern about losing their health insurance more frequently than white, non-Hispanic, but all groups reported some concern related to this (see Table 7).

Finally, in the past year, 20% of respondents reported that they were aware of a merger or acquisition in their community. Among those who said they noticed changes following the merger or acquisition, most reported

• 23%— My doctor is no longer in network
• 23%— I have fewer choices of providers
• 22%— I have to pay more for my care
• 15%— I have experienced lower quality care

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

• 27%—I’m concerned I will have to pay more to see my doctor;
• 21%—I’m concerned my doctor may no longer be covered by my insurance;
• 20— I’m concerned I will have fewer choices of where to receive care;
• 14%— I’m concerned I will have a lower quality of care; and
• 11%—I’m concerned I will have to travel farther to see my doctor

Respondent Perceptions of the Health System, Policy Solutions

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

• 73% 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

Oklahoma respondents view government as the primary actor responsible for fixing health system problems. They also rank addressing healthcare issues among the top priorities for their elected officials. Respondents also viewed drug companies as bearing the greatest responsibility for high healthcare costs and reining in drug prices as the highest priority to address the healthcare affordability burden (Table 8).

An overwhelming 80% of respondents say that it should be required to disclose how proposed laws and legislative mandates impact costs to healthcare consumers, taxpayers and businesses. Only 43% say that health insurance should be mandated to cover the cost of more services, even it means health insurance costs go up for everyone, and only 31% say that laws should be passed to help local pharmacies, even if it means the cost of prescription drugs increase for everyone. These data indicate that cost and affordability are priorities over convenience for a majority of respondents.

Moreover, addressing healthcare 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% — Healthcare
• 44% — Economy/Joblessness
• 32% — Taxes

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

• 44% — Ensure everyone has access to health coverage;  
• 38% — Lower what you pay out of pocket for hospital and healthcare services;
• 34% —Improve affordability in the private health insurance market.

Oklahoma respondents most frequently reported believing that the responsibility for high healthcare costs lies with industry stakeholders, such as:

• 74% — Drug companies;  
• 70% — Health insurance; and 
• 53% — Hospitals.

Support for Policy Solutions

When it comes to tackling costs, respondents endorsed a number of strategies to rein in healthcare costs (see Table 8). For example, across all political affiliations, 90% of respondents want limits on how quickly drug prices can rise, and 91% believe the government should cap the price of expensive prescription drugs. More than 92% support restricting extra charges like facility fees when care isn’t delivered on a hospital campus, and 91% say hospitals should be prevented from charging more for routine services typically provided in a doctor’s office.