KEY FINDINGS

A survey of more than 1,400 New York state adults, conducted from December 26, 2024, to January 3, 2025, found that:

• Over two-thirds (68%) experienced at least one health care affordability burden in the past year;
• 4 in 5 (80%) worry about affording health care in the future;
• 2 in 3 (66%) of all respondents delayed or went without health care due to cost in the last 12 months;
• Low-income respondents and those with disabilities had 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, New York adults experience hardship due to high health care costs. In the past 12 months, nearly seven out of 10 (68%) respondents experienced at least one of the following health care affordability burdens:

1) BEING UNINSURED DUE TO HIGH COSTS

Over a third of (35%) 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, 47% of respondents without dental insurance and 33% 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

Two-thirds (66%) of all respondents reported delaying or going without health care during the prior 12 months due to cost:

• 22%—Delayed going to the doctor or having a procedure done
• 22%—Cut pills in half, skipped doses of medicine or did not fill a prescription¹
• 21%—Skipped needed dental care
• 21%—Skipped a recommended medical test or treatment
• 16%—Had problems getting mental health care or addiction treatment²
• 15%—Avoided going to the doctor or having a procedure done altogether
• 13%—Skipped needed vision services

Moreover, respondents most frequently cited not being able to get an appointment as the reason for them or their family members not getting care in the last year (19%), followed by cost (16%), exceeding 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). Nearly one-third (31%) of respondents reported experiencing one or more of these struggles to pay their medical bills:

• 11%—Used up all or most of their savings
• 10%—Were unable to pay for basic necessities like food, heat or housing
• 10%—Were contacted by a collection agency
• 10%—Racked up large amounts of credit card debt
• 8%—Borrowed money, got a loan or another mortgage on their home
• 6%—Were placed on a long-term payment plan
• 4% – Asked for donations (GoFundMe campaigns)

HIGH LEVELS OF WORRY ABOUT AFFORDING HEALTH CARE IN THE FUTURE

New York respondents also exhibit high levels of worry about affording health care in the future. Over four in five (80%) reported being “worried” or “very worried” about affording health care in the future, including:

• 65%—Cost of nursing home or home care services
• 62%—Health insurance will become unaffordable
• 61%—Medical costs when elderly
• 58%—Medical costs in the event of a serious illness or accident
• 52%—Cost of dental care
• 51%—Prescription drugs will become unaffordable
• 46%—Cost of needed vision services
• 43%—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. Respondents aged 35-54 reported the highest worry about medical costs in old age, and those aged 44-64 were most concerned about affording nursing home or home care costs. This suggests that New York respondents may be worried about affording the cost of care for both aging relatives and themselves.

Concerns about health care affordability were consistent across all respondent income levels, races, ethnicities, geographic settings, and abilities (see Table 1). Worry about affording health care was highest among respondents living in lower to middle-income households, those with a disabled household member, and those in the New York City (see Table 1). Overall, 88% of respondents with an annual household income between $50,000 and $100,000 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

HIGH LEVELS OF WORRY ABOUT AFFORDING OR LOSING COVERAGE

Respondents reported worry about insurance becoming unaffordable more frequently than worry about losing coverage across all income levels, regions, races/ethnicities, and coverage types, regardless of where they lived in New York State (NYC, Long Island, or Upstate) (see Table 2).

Concern that health insurance will become unaffordable was most prevalent among those with insurance purchased through their employer (see Figure 1), those earning $50,000 – $100,000.  Likewise, respondents of color and those living in a household that includes a person with a disability also reported the highest rates of concern that health insurance will become unaffordable (see Table 2).

Although concerns about affording coverage surpassed fears about losing coverage, over two-thirds of respondents were concerned about losing health insurance coverage if they purchased coverage independently (73%) or through employment (68%) (see Figure 1).  Respondents of color were more worried about losing coverage than their White counterparts (66% vs. 58) (see Table 2).

DIFFERENCES IN HEALTH CARE AFFORDABILITY BURDENS

The survey also revealed differences in how New York respondents experience health care affordability burdens by income, age, geographic setting, disability, race and ethnicity.

INCOME AND AGE

Moderate-income respondents most frequently reported experiencing one or more health care affordability burdens. Nearly four out of five (78%) respondents earning less than $75,000 per year reported struggling to afford 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 going without care and rationing their medication due to cost (see Figure 3).

Further analysis found that New York respondents aged 25-34 reported the highest rates of forgoing care due to cost. However, at least half of respondents aged 18-54 reported going without care due to financial barriers, signaling that the issue extends across age groups. Likewise, respondents aged 18-44 most frequently reported rationing medication due to cost compared to other age groups (see Figure 4).  

DISABILITY

Respondents living in households with a person with a disability reported the highest rates of forgoing care and rationing medication due to cost. Of those included in this group, 76% reported going without some form of care, and 31% 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 (63%) and rationing medication (19%) due to cost (see Table 4).

Additionally, respondents living in households with a person with a disability 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).

Those with disabilities also face health care affordability burdens unique to their disabilities— 10% of respondents 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 4% 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 varying ways. Those 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 New York, respondents enrolled in Medicaid and purchase insurance on their own reported the highest rates of going without care due to cost and rationing medication. (see Table 4). Still, a large portion of people that have insurance through an employer (66%) or have Medicare (45%) also went without care due to cost in the 12 months prior to taking the survey.

RACE AND ETHNICITY

Respondents of color reported going without care due to cost more frequently than white respondents. Similarly, these respondents also reported rationing medication due to financial concerns at higher rates than white respondents. There are a variety of potential consequences related to postponing health care and medication rationing, highlighting the importance of addressing cost-related barriers to address health disparities.

In New York, 81% of Hispanic/Latino respondents reported going without care due to cost in the past 12 months compared to 60% of White alone, non-Hispanic/Latino respondents (see Table 4). Further analysis showed that Hispanic respondents also reported higher rates of skipping dental services, vision services, and recommended medical tests or treatments (see Figure 5).

In an effort to explore the impact high health costs have on individuals, respondents were also asked to describe a time when they were unable to get health care due to cost (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. To explore the impact of unaffordable medical care, survey participants were asked whether they have had to do any of the following due to the cost of medical bills in the past 12 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 with disabilities experienced the highest rate of medical cost burdens (54%). Residents of New York City (44%), Hispanics/Latinos (39%) and people of color (36%) were more likely to experience medical debt more frequently than people residing elsewhere in the State and White respondents. Likewise, respondents with health insurance purchased independently, reported the highest rates of the above burdens due to medical bills (45%) compared to respondents with all other insurance types (18%-38%) (see Table 6).

IMPACT OF AND WORRY RELATED TO HOSPITAL CONSOLIDATION*

In addition to the above health care affordability burdens, a small share of New York respondents reported being negatively impacted by health system consolidation. Between 2000 to 2024, there have been 53 hospital closures and a reduction of 18.8% of beds because of restructuring through changes in ownership involving hospitals through mergers, acquisitions, or CHOW in New York.^{4,5, 6,7}

New York requires that the State Attorney General or Court System be notified of all non-profit hospital transactions and grants the authority to approve or deny transactions. The state does also require pre-transaction notice of transactions of all hospitals and provider organizations.⁶  However, New York does not require that nonprofit hospitals provide annual reports indicating that the change in ownership has not negatively impacted access to health services in the affected communities for five years following the transaction. Nor does it monitor the impact changes in ownership have on local health care prices after they occur.

In the past year, 32% of respondents reported that they were aware of a merger or acquisition in their community—of those respondents, 25% reported that they or a family member were unable to access their preferred health care organization because of a merger that made their preferred organization out-of-network. Out of those who reported being unable to access their preferred health care provider due to a merger:

• 43% 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,
• 40% skipped recommended follow-up visits due to a merger,
• 34% changed their preferred doctor or hospital to one that is in-network,
• 27% skipped filling a prescription medication,
• 25% changed their health plan coverage to include your preferred doctor or hospital, and
• 24% switched to telehealth options to continue seeing their preferred doctor.

While a smaller portion of respondents reported being unable to access their preferred health care organization because of a merger, far more respondents (62%) 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:

• 32% — I’m concerned my doctor may no longer be covered by my insurance
• 26% — I’m concerned I will have fewer choices of where to receive care
• 16% — I’m concerned I will have to pay more to see my doctor
• 13% — I’m concerned I will have to travel farther to see my doctor
• 11% — I’m concerned I will have a lower quality of care

_{*Note: The sample size of respondents who said they were affected by a merger 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 New York respondents’ health care affordability burdens and concerns, it is not surprising that they are dissatisfied with the health system. Of the respondents surveyed:

• Just 33% agreed or strongly agreed that “we have a great healthcare system in the U.S.,”
• While 76% 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

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

• 56% of respondents reported researching the cost of a drug beforehand, and
• 71% said they would be willing to switch from a brand name to an equivalent generic drug if given the chance.

GOVERNMENT ACTIONS

New York respondents see the 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:

• 54% — Health care
• 41% — Economy/Joblessness
• 39% — Immigration

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

• 48% — Address high health care costs, including prescription drugs
• 33% — Preserve consumer protections preventing people from being denied coverage or charged more for having a pre-existing medical condition
• 33% — Improve Medicare, coverage for seniors and those with serious disabilities
• 29% — Get health insurance to those who cannot afford coverage

Out of 15 possible options, New York respondents most frequently reported believing that the reason for high health care costs is unfair prices charged by powerful industry stakeholders, such as:

• 75% — Drug companies charging too much money
• 74% — Insurance companies charging too much money
• 72% — Hospitals charging too much money  

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

• 95% — Make it easy to switch insurers if a health plan drops your doctor 
• 93% — The government should require drug companies to provide advance notice of price increases and information to justify those increases.
• 93% — Show what a fair price would be for specific procedures
• 93% — Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes
• 92% — Require hospitals and doctors to provide up-front cost estimates to consumers
• 92% — Require insurers to provide up-front cost estimates to consumers
• 92% ­— Cap out-of-pocket costs for life-saving medications, such as insulin
• 90% — Set standard prices for drugs to make them affordable
• 86% – Require that routine health care services should cost the same no matter what kind of facility those services are conducted in
• 86% – Create an independent office to monitor statewide health care spending and set targets to limit spending increases with the goal of improving affordability for all New Yorkers
• 79% – Require health insurance companies to gradually increase spending on primary care

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 December 26, 2024 to January 3, 2025, used a web panel from Dynata with a demographically balanced sample of approximately 1,500 respondents who live in New York. 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 1,397 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.