A survey of more than 1,300 Utah adults, conducted from May 18 to June 3, 2023, found that:
Like many Americans, Utah adults experience hardship due to high healthcare costs. All told, over two-
thirds (69%) of respondents experienced one or more of the following healthcare affordability burdens in
the prior 12 months:
1) Being Uninsured Due to High Costs
Roughly one-half (51%) of uninsured respondents cited “too expensive” as the major reason for not having coverage, far exceeding other reasons like “don’t need it” and “don’t know how to get it.”
2) Delaying or Going Without Healthcare Due to Cost
Nearly half (63%) of all respondents reported delaying or going without healthcare during the prior 12
months due to cost:
Moreover, of respondents who reported a delay or foregoing healthcare, the most cited reason for them
or a family member not getting needed medical care in the past year was cost, exceeding a host of other
barriers like getting an appointment, getting time off work, transportation and lack of childcare.
3) Struggling to Pay Medical Bills
Other times, respondents got the care they needed but struggled to pay the resulting bill. Over two in
five (45%) experienced one or more of these struggles to pay their medical bills:
Of the various types of medical bills, the ones most frequently associated with an affordability barrier
were doctor bills, dental bills and prescription drugs. The high prevalence of affordability burdens for
these services likely reflects the frequency with which Utah respondents seek these services. Trouble
paying for dental bills likely reflects lower rates of coverage for these services.
Utah respondents also exhibit high levels of worry about affording healthcare in the future. Over four in
five (86%) reported being “worried” or “very worried” about affording some aspect of healthcare in the
While two of the most common worries—affording the cost of nursing home or home care services and
medical costs when elderly—are applicable predominantly to an older population, they were most
frequently reported by respondents ages 25-54. This finding suggests that Utah respondents may be
worried about affording the cost of care for both aging relatives and themselves.
Worry about affording healthcare was highest among respondents living in lower- and middle-income
households and among those living in households with a person with a disability (see Table 1). More than 4 in 5 (91% of) respondents with household incomes of less than $75,000 per year2 reported worrying about affording some aspect of coverage or care in the past year. Still, most Utah respondents of all incomes, races, ethnicities, geographic setting and levels of ability are somewhat or very concerned.
Concern that health insurance will become unaffordable is also more prevalent among certain groups of
Utah respondents. By insurance type, respondents with coverage that they have purchased on their own,
not through their employer, most frequently reported worrying about affording coverage, followed by
respondents with coverage through their employer and those with Utah Medicaid (see Figure 1).
Respondents with household incomes below $50,000 per year reported the highest rates of worry about
losing coverage, while those with household incomes below $75k reported the highest rates of worry
about affording coverage. Respondents of color and those living in households with a person with a disability reported higher rates of both worrying about losing insurance and worry about health insurance becoming unaffordable in the future compared to white alone, non-Hispanic/Latino respondents and those not living with a disabled household member (see Table 2). Respondents with Medicaid and those purchasing health insurance on their own (such as through the health insurance marketplace) reported the highest rates of worrying about losing their insurance compared to those with employer-based insurance or Medicare. Concerns about affording coverage exceeded fears about losing coverage across all income groups, disability statuses, geographic settings, race, ethnicity and coverage types.
The survey also revealed differences in how Utah respondents experience health care affordability
burdens by income, age, geographic setting, race, ethnicity, and disability status.
Income and Age
Unsurprisingly, respondents at the lowest end of the income spectrum most frequently reported
experiencing one or more healthcare affordability burdens, with 79% of those earning less than $50,000
per year reporting struggling to afford some aspect of coverage or care in the past 12 months (see Figure 2). This may be due, in part, to respondents in this income group reporting higher rates of going without care and rationing their medication due to cost (see Figure 3). Still, 70% of those earning $75,001 to $99,999 reported experiencing affordability burdens, demonstrating that people across the income spectrum experience these challenges.
Further analysis found that Utah respondents ages 18-44 reported higher rates of going without care due
to cost than respondents ages 45 and up (see Figure 4). In addition, respondents ages 18-54 also most
frequently reported rationing medication due to cost compared to other age groups.
Respondents living in households with a person with a disability reported the highest rates of going
without care and rationing medication due to cost in the past 12 months. Over 3 in 4 (77% of) respondents
in this group reported going without some form of care and 49% reported rationing medication,
compared to 56% and 28% of respondents living in households without a person with a disability,
respectively (see Table 3). Respondents living in households with a person with a disability also more
frequently reported delaying or skipping getting mental healthcare, addiction treatment and dental care,
among other healthcare services, than those in households without a person with a disability due to cost
concerns (see Table 3).
Those with disabilities may also face healthcare affordability burdens unique to their disabilities—29% of
respondents reporting a disability in their household reported delaying getting a medical assistive device
such as a wheelchair, cane/walker, hearing aid or prosthetic limb due to cost. Just 8% of respondents
without a person with a disability (who may have needed such tools temporarily or may not identify as
having a disability) reported having this experience.
Respondents with Utah Medicaid coverage reported the highest rates of going without care due to cost
and rationing medication, followed by respondents with health insurance they bought on their own and
those with employer-sponsored insurance (see Table 4). Still, nearly two-fifths of respondents with
Medicare went without care due to cost in the twelve months prior to taking the survey.
Survey respondents also had the opportunity to share their own stories about going without care due to
cost in the past year. Notably, respondents with both private insurance and Medicaid coverage reported
challenges affording care (see Table 5).
Race and Ethnicity
Utah respondents of color reported slightly higher rates of rationing medication and forgoing care than
white respondents. Sixty-six percent (66%) of respondents of color went without care due to cost,
including 70% of Hispanic/Latino respondents, compared to 62% of white alone, non-Hispanic/Latino respondents (see Table 3). Further analysis showed that Hispanic/Latino respondents reported higher rates of challenges receiving mental health care and avoiding going to the doctor or getting a procedure altogether (see Figure 5).
Encountering Medical Debt
The survey also showed differences in the prevalence of financial burdens due to medical bills, including
going into medical debt, depleting savings and being unable to pay for basic necessities (like food, heat
and housing) by income, race, ethnicity, disability status and geographic setting. Fifty-four percent of
respondents of color reported going into debt, depleting savings or going without other needs due to
medical bills, including 60% of Hispanic/Latino respondents, compared to 42% of white respondents (see
The rate of financial burden is even higher for respondents who have or live with a person with a disability,
with nearly 3 in 5 (60%) reporting going into debt or going without other needs due to medical bills,
compared to 37% of respondents living in households without a disabled member. In addition, respondents with Utah Medicaid and those who purchased health insurance on their own reported the highest rate of the above financial burdens due to medical bills (58% and 55%, respectively) compared to those with other insurance types.
Impact of Hospital Consolidation
In addition to the above healthcare affordability burdens, a small share of Utah respondents have been
negatively impacted by health system consolidation. In 2019 and 2020, two hospitals in the state changed
ownership through either a merger, acquisition, or change of ownership (CHOW).3,4 Relative to other
states, Utah has few regulations surrounding hospital change of ownership, with no provisions requiring
notice, review or approval of any health care acquisitions mergers or consolidations.5
In the past year, 9% of all respondents reported that they or a family member were unable to access their
preferred health care organization because of a merger that made their preferred organization out-of-
network. Out of those who reported being unable to access their preferred healthcare provider due to a
Out of those who reported that the merger caused an additional burden for them or their families, when
asked about the greatest burden hospital mergers had created for respondents and their families, the top
three most frequently reported issues were:
In light of Utah respondents’ healthcare affordability burdens and concerns, it is not surprising that they
are dissatisfied with the health system:
To investigate further, the survey asked about both personal and governmental actions to address health
Utah respondents see a role for themselves in addressing healthcare affordability. When asked about
specific actions they could take:
When asked to select the top three personal actions they felt would be most effective in addressing healthcare affordability (out of ten options), the most common responses were:
But far and away, Utah respondents see government as the key stakeholder that needs to act to address
health system problems. Moreover, addressing healthcare problems is one of the top priorities that
respondents want their elected officials to work on.
At the beginning of the survey, respondents were asked what issues the government should address in the upcoming year. The top vote getters were:
When asked about the top three healthcare priorities the government should work on, the top vote getters were:
Of more than 20 options, Utah respondents believe the reason for high healthcare costs is unfair prices
charged by powerful industry stakeholders:
When it comes to tackling costs, respondents endorsed a number of strategies, including:
There is also remarkable support for change regardless of respondents' political affiliation (see Table 7).
The high burden of healthcare affordability, along with high levels of support for change, suggest that
elected leaders and other stakeholders need to make addressing this consumer burden a top priority.
Moreover, the COVID crisis has led state residents to take a hard look at how well health and public health systems are working for them, with strong support for a wide variety of actions. Annual surveys can help assess whether progress is being made.
Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ unbiased views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions.
This survey, conducted from May 18 to June 3, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,504 respondents who live in Utah. Information about Dynata’s recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,368 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:
Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.