This brief was funded by the California Health Care Foundation (CHCF).
Authors: Lacey Hartman, Senior Research Fellow, SHADAC and Colin Planalp, Senior Research Fellow, SHADAC
While uninsurance rates in the United States and in California have significantly decreased since the implementation of the Affordable Care Act (ACA), health care costs remain an issue into the present.
In this brief for the California Health Care Foundation (CHCF), we use California Health Interview Survey (CHIS) data to better understand health care costs in California, including whether and how affordability may have changed between 2019 and 2024. We also use Current Population Survey (CPS) data in order to compare health care costs and affordability measures in California to the United States to see how those in California experience health care costs compared to the nation as a whole.
This work helps us understand the impact of pandemic-era policy interventions on health care costs and affordability. Not only that, but it also provides us with an important baseline in advance of sweeping federal policy changes enacted by budget reconciliation bill H.R. 1, such as changes to Medicaid, alongside the expiration of enhanced federal subsidies, which, combined, will likely reduce coverage and increase health care costs for millions in CA and beyond.
Study Measures and Key Takeaways
For this analysis, we looked at four measures of health care affordability, and tested for changes over time and between demographic groups.
The measures are as follows:
- Health Insurance Deductibles—What shares of Californians report having deductibles of $2,000 or more?
- Medical Bills—What shares of Californians report having trouble paying medical bills? How large are those medical bills they have trouble paying?
- Impacts of Medical Bills—What shares of Californians report entering credit card debt to finance medical bills? What shares report that trouble paying medical bills made it difficult to afford basic necessities (food, housing)?
- High Burden Spending—How does CA compare to the U.S. on share of people who report spending 10% or more of their income on health care costs (e.g., premiums, deductibles, co-pays, etc.)?
The data for the first three measures come from the CHIS, while the high burden spending measure uses CPS data that allows comparisons between CA and the U.S.
Just some of the key findings from this issue brief include:
- Problems Paying Medical Bills Declined in CA, Overall. The percentage of Californians who reported problems paying medical bills declined from 2019 (13.3%) to 2024 (11.8%).
- Statewide, Other Health Care Affordability Measures Held Steady. Medical bill impacts like having trouble paying for basic necessities (food, housing), taking out credit card debt to finance health care bills, and having bills larger than $4,000 were statistically unchanged from 2019 to 2024 looking at California as a whole.
- Percentage of People Reporting Large Deductibles Increased. The share of Californians reporting large deductibles (of $2,000 or more) increased from 34.8% in 2019 to 37.8% in 2024—this increase was mostly concentrated in certain populations, including those with employer-sponsored insurance (ESI).
- Disparities Persist Across Measures by Income, Race/Ethnicity, Coverage Type, and Region. For example, Latino/x Californians reported trouble paying medical bills at higher rates than White Californians in 2024 (13.5% and 11.5%, respectively). Additionally, Latino/x and Black Californians reported higher rates of difficulty affording basic necessities due to medical bills than White Californians.
“While federal and state policies may have helped to mitigate some health care affordability concerns in recent years, the evolving federal health policy landscape raises doubts as to whether that relative stability will continue, and for whom,” writes lead author and SHADAC Senior Research Fellow Lacey Hartman.
For the rest of our findings along with detailed tables, charts, and discussion of results, read the full brief here.