Summary

Variations in Health Care Affordability Between Households

Factors like household income and composition impact how a person navigates the health care system. For example, Tennessee respondents in households earning less than $50,000 a year reported experiencing a health care affordability burden more frequently than wealthier households (see Table 1). The median household income in Tennessee in 2024 was $71,997.¹

Respondents that earn less than $50,000 annually frequently reported experiencing a cost burden due to medical bills, like incurring medical debt, depleting savings, or sacrificing basic needs like food, heat, or housing. Still, over half of respondents living in higher income households also faced affordability issues, indicating that these burdens affect all income groups. At least 69% of respondents across all income levels expressed concern about affording health care now or in the future.

Similar to income, household composition can also influence the types of challenges that people are exposed to when navigating the health care system. People with a physical or cognitive impairment, for instance, interact with the health care system more often than others, which frequently results in greater out-of-pocket costs.² Tennessee respondents with a physical or cognitive impairment, or who live with a person with a physical or cognitive impairment, reported experiencing an affordability burden or concern more frequently than other respondents (see Table 2).

Additionally, 13% of respondents with a physical or cognitive impairment, or who live with a person with a physical or cognitive impairment, 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 4% of respondents without a physical or cognitive impairment who may have required one of these tools for temporary support.³

Variations in Health Care Affordability Between Demographic Groups

Research has shown that demographic differences persist in self-reported health status, access and affordability.⁴ This survey also revealed variations in reported affordability burdens between demographic groups. For example, Tennessee 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 without a formal education beyond a high school diploma or GED reported experiencing a health care affordability burden (81%), and a health care cost burden due to medical bills (44%) more frequently than other respondents (see Table 3).

Likewise, respondents of color reported higher rates of many affordability burdens compared to white alone, non-Hispanic respondents (see Table 4). A small share of respondents also reported unique challenges to care that were unique to their backgrounds. Thirty (2% of) respondents reported not getting needed medical care because they couldn’t find a doctor of the same background as them and 19 (1% of) respondents reported not getting needed care because they couldn’t find a doctor who spoke their language.  

Differences in the frequency of reported health care affordability burdens and concerns by sex also emerged in the survey results (see Table 5). Women reported similar rates of experiencing at least one affordability burden in the past year (74% versus 74%); 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 female respondents reported being worried about affording some aspect of coverage or care compared to male respondents (77% versus 74%), although a slightly higher percentage of male respondents reported experiencing a cost burden due to medical bills (48% versus 42%).

Trust and Respect

Negative experiences in the health care system can increase mistrust, and whether a patient trusts or feels respected by their health care provider may influence their willingness to seek necessary care.^8,9 In Tennessee, 33% of respondents reported feeling that their health care providers never, rarely, or only sometimes treat them with respect, and 66% reported they were not confident in being able to find a doctor that they like or trust.

Overall, 46% reported distrust or perceived disrespect from their providers, and 27% went without care because of a lack of trust or perceived disrespect. Certain groups reported forgoing care at higher rates due to these experiences – while over a third (37%) of respondents enrolled in TennCare, the Tennessee Medicaid program, reported going without care due to distrust or perceived disrespect, only 30% of individuals with employer-sponsored insurance reported the same (see Table 7).

Thirty-three percent of Tennessee respondents reported feeling disrespected by a health care provider. When asked why they believe their providers did not treat them with respect, the most frequently cited reasons include: income or financial status (39%); race (26%); where they live (22%); disability (20%); ethnic background (20%); gender or gender identity (15%); and educational attainment (13%). In lesser numbers, some respondents also cited sexual orientation (6%), and experience with violence or abuse (8%).

When asked to describe how their identities or circumstances have impacted their ability to access quality, patient-centered care respondents offered a variety of examples, including:

Negative experiences when seeking care can contribute to a lack of trust in the health care system, leading to poorer health outcomes and higher costs. Respondents reported that they believe that both individual practices and beliefs, as well as  policies and practices built into the health systems are factors can impede the quality of care received – in fact, fifty-seven percent (57%) of respondents 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 why, respondents most frequently cited policies and practices built into the health care system (15%), the actions and beliefs of individual health care providers (17%), and an equal mixture of both of these factors (38%).

Nearly three in every four (72% of) Tennessee respondents agreed or strongly agreed that the U.S. health care system needs to change. Interestingly, there is bipartisan support for government-led solutions for more information on the types of strategies Tennessee residents support, see: Tennessee 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 (September 2025).