Low-income Californians and Health Care
Health Care Priorities
When asked about a number of health care issues facing the state and its residents, Californians with low incomes say most are important priorities for state political leaders to address. About half of low-income Californians say that it is “extremely important” for the governor and the legislature to work on making sure people with mental health problems can get treatment (51 percent) and to work on making sure all Californians have access to health insurance (49 percent). Nearly half say it is “extremely important” that the governor and legislature work on lowering the amount people pay for health care (46 percent) and on making sure there are enough health care providers across the state (46 percent). Sixteen percent of Californians with low incomes think it is “extremely important” for state leaders to work on decreasing state spending on health care (Figure 1). While ratings of health care priorities are similar across income levels, Californians with low self-reported incomes are more likely than those with higher incomes to say making sure there are enough health care providers across the state should be an “extremely important” priority for state leaders (46 percent versus 33 percent [not shown]).
Experiences with Health Care Affordability
Californians with low incomes are nearly twice as likely as those with higher incomes to say they or a household member had problems paying medical bills in the past 12 months (29 percent versus 15 percent) (Figure 2).
Many Californians with low incomes who had problems paying medical bills report having to cut back in other areas, dip into savings, or borrow money to help address their medical costs. Among the 29 percent of low-income Californians who report problems paying medical bills, nearly three-quarters (73 percent) say they have cut spending on household items to pay medical bills. Two-thirds (67 percent) say they used up all or most of their savings and about six in ten say they put off a vacation or major purchase (63 percent) or borrowed money from friends or family (60 percent) (Figure 3).
More than half of Californians with low incomes (55 percent) say that they or a family member living in their household delayed or went without some type of medical or dental care in the past year because they had difficulty affording the cost. This compares to 36 percent of those with higher incomes (not shown). Four in ten low-income Californians say someone in their household skipped dental care or checkups, 28 percent say they or a household member put off or postponed getting health care, and about a quarter say someone in their household skipped a recommended test or treatment (24 percent) or did not fill a prescription (24 percent) because of cost (Figure 4).
Three in four low-income Californians (75 percent) say they are very or somewhat worried about being able to afford unexpected medical bills, outranking other financial worries asked about in the survey, including paying for housing. Nearly seven in ten (68 percent) say they are worried about affording out-of-pocket costs for health care services (Figure 5).
Cost concerns are also evident among low-income adults who are uninsured. Among uninsured Californians age 18–64 with low incomes, about half (49 percent) say they have been without health insurance for two years or more, and cost and affordability (28 percent) is the top reason cited for why they lack insurance (Figure 6).
Access to Providers
A majority of low-income Californians (56 percent) say their community does not have enough mental health care providers to serve the needs of local residents. Those with low incomes are more likely than Californians with higher incomes to say their community does not have enough primary care doctors (41 percent versus 31 percent), specialists (42 percent versus 24 percent), and hospitals (34 percent versus 22 percent) (Figure 7).
About half of Californians with low incomes (52 percent) say most people in the state with mental health conditions are not able to get the services they need. A similar share (47 percent) say those with alcohol or drug use problems in California are not able to get needed services (Figure 8).
Similar shares of Californians across income levels say they or a family member have sought counseling or treatment for alcohol or drug use (Figure 9).
Californians with low incomes are slightly more likely than those with higher incomes to say they or a family member sought counseling or treatment for a mental health condition, such as anxiety or depression, in the past twelve months (29 percent versus 23 percent) (Figure 9).
Among Californians with low incomes, concerns about availability and access to providers are reflected in their personal experiences. About a quarter of low-income residents (27 percent) say there was a time in the past 12 months when they had to wait longer than they thought reasonable to get an appointment for medical care. Among low-income adults who say they or a family member sought mental health treatment in the past year, 27 percent said they had to wait longer than they thought reasonable for a mental health care appointment (Figure 10).
Among low-income Californians with Medi-Cal coverage who say they or a family member sought care, 33 percent report having to wait longer than they thought reasonable for a medical care appointment and four in ten (41 percent) say they had to wait longer than reasonable for a mental health care appointment (Figure 10).
Importance of Medi-Cal
An overwhelming majority of low-income Californians say Medi-Cal is “very important” (84 percent) or “somewhat important” (10 percent) to the state. Eight in ten (81 percent) say it is either “very important” (69 percent) or “somewhat important” (11 percent) to them and their family. While an overwhelming majority of Californians with higher incomes also see Medi-Cal as important to the state (90 percent), they are less likely than those with low incomes to say the program is important to their own families (39 percent versus 81 percent) (Figure 11).