Nevada and Washington Residents Struggle to Afford Health Care, Support Government Action to Address Costs

Concerns about the affordability of health care have been increasing over time and will be exacerbated in the short run by high rates of inflation affecting expenses such as food and housing.  Two recent state surveys shed light on how these challenges affect people specifically — and how they think these issues should be addressed. 

 In Nevada and Washington, over 60% of survey respondents reported that they experienced affordability burdens within the last 12 months and there was strong support for government-led change across party lines, according to recently published findings from the Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey (CHESS). CHESS is designed to examine respondents’ views on: 

• confidence in using the health system; 
• financial burden or tradeoffs experienced due to cost of health care; 
• worries about affording health care services; and 
• views on policy fixes.   

The surveys show that residents in Nevada and Washington — two very different states in terms of political leanings and overall health system performance — have strikingly similar views about health care affordability and potential solutions. And both states have cost growth target programs designed to improve health spending transparency and accountability. Through such programs, state officials work with health care stakeholders to set a per–capita cost growth target that enables them to identify and address drivers of cost growth. Nevada and Washington receive technical assistance for this work from Bailit Health through the Peterson-Milbank Program for Sustainable Health Care Costs.  

“The CHESS findings suggest that of 1,130 Nevadans surveyed, 65% worry about whether they can afford the cost of health care; and perhaps most astoundingly, over half reported experiencing delays or gaps in accessing health care over the past 12 months due to the cost,” said Malinda Southard, executive director of the Nevada Patient Protection Commission (PPC). “This valuable insight comes at a critical moment for the Commission with proposed legislation in 2023 to codify the health care cost growth benchmark. If passed, this will be a landmark step toward improving health care affordability and transparency for patients in our state, and to help curbing the climbing cost of health care.”  

Survey Findings 

Affordability burdens. Affordability burdens tracked in CHESS include delaying or avoiding care or rationing medication, receiving care but struggling to pay health care bills, and being uninsured due to cost (see table).  

Source: Healthcare Value Hub 

Disparities in Affordability. While most people in these states experienced affordability burdens, there were persistent demographic disparities associated with race/ethnicity, geographic location, income level, insurance type, and disability status. In both states, rural residents were most likely to skip care due to cost, but more than half of those in non-rural areas also went without needed care. In both states, having at least one member with a disability in the household was strongly associated with missed care or prescription drug rationing. And people of color in both states were more likely to report going without care and rationing medication than White respondents. 

Different Affordability Challenges. The survey showed financial hardships exist across all categories, but there were differences in prevalence of financial hardship because of medical bills, such as medical debt, depleting savings and being unable to pay for basic necessities (like food, heat and housing) by income, race, disability status and geographic setting. 

Majorities worry for the future. In both states, more than 80% of respondents worried about affording health care in the future, including the costs of nursing home or home care, medical costs when elderly, and health insurance costs. 

Broad support for government solutions. In both states, respondents supported government-led interventions, such as increased health care cost transparency, to increase affordability regardless of political affiliation.   

Source: Healthcare Value Hub 

“Community voices are key to the work of reducing health care costs,” said Sue Birch, director of the Health Care Authority and chair for Washington State’s Health Care Cost Transparency Board. “We’re excited to see this partnership between Altarum and our Washington consumer advocates. This kind of work helps keep the focus where it belongs — on providing affordable access to health care — especially for our most vulnerable populations.”