State and Federal Aid Prevented a Deep Setback in California Health Care Affordability in 2020


In 2020, the onset of the COVID-19 pandemic meant the imposition of incredible burdens on all corners of American society, especially the healthcare system and the people it serves. There were well-founded fears that the pandemic and concurrent economic crisis would make health insurance and health care unaffordable for even more people – already a long-standing problem in California.

In response to the pandemic, the US government has implemented historic relief programs, including multiple instances of direct cash payments to a majority of American families. These federal policies coincided with California’s health insurance reforms which, although developed before the pandemic, were implemented in 2020.

As a result, despite the COVID-19 crisis — and perhaps in large part because of pandemic relief programs and California’s own reforms — data from the California Health Insurance Survey (CHIS) shows that Californians were largely protected against a major erosion of their ability to pay for health insurance and care. Despite this overall positive result, CHIS 2020 data on healthcare affordability continued to demonstrate clear inequalities based on income and race/ethnicity.

Main findings

  • The rate of uninsured people in California is decreasing, but cost remains the main reason for lack of health insurance. The rate of Californians under 65 without health insurance hit an all-time low of 7.0% in 2020. However, 51.9% of uninsured people said they did not have coverage because it was too expensive.
  • The rate of going without necessary care due to falling costs in 2020. Of the 8.6% of Californians who said they had given up on needed medical care in 2020, 32.0% said concerns about costs caused them to go without care. This rate was significantly lower than the rate of 43.6% in 2019.
  • Fewer Californians reported difficulty paying their medical bills. From 2019 to 2020, the rate of Californians reporting having had difficulty paying their medical bills in the past year decreased significantly, from 13.3% to 11.1%. However, when disaggregating the data by income, only those with higher incomes experienced a statistically significant improvement. Low-income Californians — 200% to 299% of the Federal Poverty Guidelines (FPG), 100% to 199% FPG, and below 100% FPG — reported no significant change.
  • Less trouble paying for necessities due to medical bills in 2020. In 2020, the rate of Californians who reported struggling to afford basic necessities (like food or clothing) due to medical bills dropped significantly, from 39.8% in 2019 to 31.0%. most income levels.
  • The practice of using credit card debt to fund medical bills has diminished. In 2020, the rate of Californians who reported incurring credit card debt to fund medical bills dropped significantly from 56.5% in 2019 to 44.3%. This finding remained consistent for Californians at all income levels — except for those with the lowest incomes.
  • Racial and ethnic disparities persisted in 2020. Although California saw significant improvements in some measures of health care and insurance affordability in 2020, some longstanding inequities persisted. For example, Blacks reported the highest rate of difficulty paying medical bills in 2020, at 14.0%, followed closely by Latinos/x, at 12.7%. Asians, Blacks, and Latinos/x also reported similarly high rates of difficulty paying for necessities due to medical bills (39.4%, 36.2%, and 33.1%, respectively).

Together, these results provide encouraging news. In a year of massive economic upheaval that would typically have caused serious financial hardship for many Californians, they instead reported improvements in health care and insurance affordability. However, the improvements were likely due, at least in part, to federal programs that were mostly designed to be temporary. Some have already expired. Additionally, the historically high inflation of 2021 and 2022 has since put a strain on people’s finances.

But the fact that California saw such measurable improvements in health insurance and health care accessibility during a broad and deep recession shows that these problems don’t have to be unsolvable. Going forward, it will be essential to monitor these measures as policymakers in California and at the federal level consider initiatives to protect people from the unaffordable costs of health care and insurance, which remain a long-term challenge. .


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