For Many Low-Income Californians, Health Care is Still Too Expensive

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Despite health coverage gains under the Affordable Care Act, many low-income Californians are still struggling to afford medical care, with more than half reportedly delaying treatment because of cost, a recent survey found.

Almost a third of state residents making under 200 percent of the federal poverty level—about $49,000 annually for a family of four—said they had problems paying medical bills in the past year, according to the survey of more than 1,400 people conducted by the Kaiser Family Foundation and California Health Care Foundation.

Affordability barriers prompted 55 percent of low-income people or their household family members to delay getting medical or dental treatment in the past year, such as check-ups, tests, prescriptions and mental health care. By comparison, 36 percent of higher-income residents and their family members delayed care, the report found.

Even when they did get medical or dental care, a majority of low-income Californians had difficulty paying for it. Almost three quarters of low-income residents said they had to cut spending on other household items to pay medical bills, and about 6 out of 10 said they’d gutted their savings, put off vacations, or had to borrow money from family or friends to pay their medical bills.

“Affordability is really a problem among low-income Californians when it comes to health care,” said Lunna Lopes, survey analyst with the Kaiser Family Foundation. “We found it pretty striking to look at low-income Californians … compared to wealthier residents.”

California has the highest poverty rate in the nation, when taking into account the state’s housing costs and other basic living expenses. Almost one in five state residents lives in poverty.

A recent budget deal approved by the state legislature is expected to ease some of health care expenses burden on low and moderate-income families. The budget, which is still awaiting Gov. Newsom’s approval, expands subsidies for people who purchase health insurance on the state’s Covered California exchange. It also reduces the amount of money some seniors have to pay toward coverage under the state’s Medi-Cal health insurance program, a situation known as the “senior penalty.”

“This budget includes significant new help for Californians to better access and afford coverage,” said Anthony Wright, who leads Health Access California, a statewide coalition of dozens of health care consumer advocacy groups. “This includes big steps toward a more affordable and accountable and universal health care system.”

Nevertheless, it’s unclear whether the budget will ease another major concern for low-income residents: access to providers, including mental health practitioners. Low-income Californians were more likely than wealthier residents to report that their community lacked enough hospitals, primary-care doctors and specialists.

Access to mental health care and substance-use treatment was a particularly big concern. About half of all Californians surveyed said they were concerned about a lack of access to these types of services.

“It was quite surprising to see mental health access come across as a real priority,” Lopes said. “That’s not just among low-income Californians but among all Californians.”

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