A survey of more than 1,300 Washington adults, conducted from August 3 to August 16, 2022, found
Race and Ethnicity
The intersection of racial disparities in health care and affordability issues impact access to care and
financial burdens for communities of color, particularly Black and Hispanic/Latino communities.1,2
In Washington, respondents of color often reported higher rates of affordability burdens than white, non-
Hispanic/Latino respondents, including going without care due to cost and facing financial challenges due
to medical bills (see Table 1). For example, 56% of Black or African American respondents incurred
medical debt, depleted savings, or sacrificed basic needs (like food, heat and housing) due to medical bills compared to 35% of white respondents.
Respondents of color more frequently went without multiple types of care due to cost, including going to
the doctor or getting a procedure done, rationing medication, and getting medical assistive devices, as
well as problems getting mental health care and addiction treatment (see Figure 1).3 For example:
The survey also revealed differences in how Washington respondents experience health care affordability
burdens by income. Unsurprisingly, respondents at the lowest end of the income spectrum most
frequently reported affordability burdens, with more than two-thirds (70%) of those with household
incomes of less than $50,000 per year struggling to afford health care in the past 12 months (see Table
2). Still, over half of respondents living in middle- and high-income households also reported struggling to
afford some aspect of coverage or care, and at least 78% of respondents in each income group reported
worrying about affording health care in the future, demonstrating that affordability burdens impact
people in each income group.
Interestingly, nearly one-third of respondents with incomes less than $50,000 and those earning $75,000
to $99,999 reported not filling a prescription, skipping doses of medicines, or cutting pills due to cost. In
addition, respondents across the income spectrum reported similar rates of financial hardships after
receiving health care services—41% of individuals who earn less than $50,000 a year went into medical
debt, depleted their savings, or sacrificed other basic needs like food, heat or housing due to medical bills,
as did 37% of those earning more than $100,000 per year.
People with disabilities often interact with the health care system more often than those without
disabilities and, as a result, tend to face more out-of-pocket costs.4 Washington respondents who have or
live with a person who has a disability more frequently reported a diverse array of affordability burdens
compared to those without a disabled household member (see Table 3). In addition, these individuals more frequently reported worrying about losing health insurance specifically (48% versus 22%).
Those with disabilities also face affordability burdens unique to their disabilities—32% of respondents
reporting a disabled person in their household delayed 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
disability (who may have needed such tools temporarily or may not identify as having a disability) reported
this experience (see Figure 2). Similarly, 39% of respondents with a disability in their household reported
problems getting mental health care compared to 15% of households without a person with a disability.
The survey also surfaced differences in health care affordability burdens and worry by gender. Women
who responded to the survey more frequently reported experiencing at least one affordability burden in
the past year than men (65% versus 58%) (see Table 4). Women also more frequently reported delaying or going without care due to cost and rationing their medications by not filling a prescription, skipping doses, or cutting pills in half. While many respondents reported being somewhat or very concerned about health care costs regardless of gender, a higher percentage of women reported worrying about affording some aspect of coverage or care than men (85% versus 78%).
Due to the small sample size, this survey could not produce reliable estimates exclusively for transgender,
genderqueer, or nonbinary respondents. However, it is important to note that these groups experience
unique health care affordability burdens—10 (1% of) survey respondents reported that they or a family
member had trouble affording the cost of gender-affirming care, such as hormone therapy or
Whether a patient trusts and/or feels respected by their health care provider may impact whether they
seek needed care. In Washington, just over 1 in 4 (28% of) respondents reported that their provider never,
rarely, or only sometimes treats them with respect. When asked why they felt health care providers did
not treat them with respect, nearly half of those respondents cited their income or financial status (46%),
followed by disability (27%), race (25%) or ethnic background (23%), and gender (24%). In lesser numbers, respondents cited experience with violence or abuse (15%) and sexual orientation (9%) as reasons for the disrespect.
Respondents of color and those with a person with a disability in their household more frequently
reported distrust in and feeling disrespected by their health care providers compared to white and non-
disabled respondents (see Table 5). They also more frequently went without medical care due to that
distrust and/or disrespect. For example, 42% of Hispanic/Latino respondents went without care due to
distrust or disrespect from health care providers compared to 25% of white, non-Hispanic respondents.
Additionally, 47% of respondents who have/are living with a person with a disability went without care due
to distrust or disrespect, compared to 17% of those without a household member with a disability.
Additionally, respondents covered through Washington Medicaid reported higher rates of distrusting or
feeling disrespected by a health care provider and higher rates of going without care due to
distrust/disrespect compared to those with private insurance and Medicare. Respondents earning less
than $50,000 most frequently reported distrust/disrespect as well as going without care due to
distrust/disrespect out of all income groups.
Respondents perceived that both individual and systemic racism exist in the U.S. health care system. Sixty- one percent (61%) of respondents believed that people are treated unfairly based on their race or ethnic background, either somewhat or very often. When asked what they think causes healthcare systems to treat people unfairly based on their race or ethnic background:
Given this information, it is not surprising that 73% of respondents agree or strongly agree that the U.S.
health care system needs to change. Understanding how the health care system disproportionately harms
some groups of people over others is key to creating a fairer and higher value system for all.
Making health care affordable for all residents is an area ripe for policymaker intervention, with
widespread support for government-led solutions across party lines. For more information on the types of
strategies Washington residents want their policymakers to pursue, see: Washington Residents Struggle to Afford High Healthcare Costs; Worry About Affording Healthcare in the Future; Support Government Action Across Party Lines, Healthcare Value Hub, Data Brief No. 135 (November 2022).
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 August 3 to August 16, 2022, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,502 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 1,347 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.