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Being Insured Isn’t Enough to Get Californians to the Doctor

Expert Views

Rebecca Catterson

June 2024

Health insurance doesn’t facilitate access to care if the following are true: you cannot afford out-of-pocket health care costs, you will not seek care because you are worried about medical debt, or you have limited access to a provider. 

In 2022, high health care costs—even for people with insurance—were responsible for one of the sharpest national increases in delayed or skipped care, with 38 percent of Americans in a Gallup poll reporting that they postponed care. 

Skipping or delaying care can lead to or exacerbate health problems, potentially impairing a person’s overall well-being and productivity and negatively affecting their families, communities, and local economies. 

Postponed care is a growing problem in California, where a rising cost of living is forcing residents to make difficult spending decisions. 

My NORC colleagues—including teammates in California—and I have been using our expertise in research design and methodology, data collection, and Medicare, Medicaid, and private health insurance to conduct several California-specific health care research projects.  

This body of work includes the annual California Health Policy Survey for the California Health Care Foundation (CHCF), which asks residents about their health care perspectives and experiences. We’ve been conducting the survey since 2020, helping identify, track, and address barriers to care so that CHCF can build a more affordable and equitable health care system for the state’s 40 million diverse residents, especially those with lower incomes or who aren’t well-served by the current system. 

Our latest survey zeroes in on Central Valley, California’s agricultural heartland.

In our latest CHCF survey, my team and I used NORC’s AmeriSpeak Panel coupled with an address-based sample to identify and interview 3,431 randomly selected representative Californians ages 18 and older. We conducted the surveys in English, Spanish, and Chinese. 

What made this survey unique was that we oversampled California’s Central Valley residents for the first time. The Central Valley is the state’s agricultural heartland and home to 1.8 million Californians, 45 percent of whom are low income and 57 percent of whom are Latino/x. We spoke with 545 residents from Fresno, Kings, Madera, Mariposa, and Tulare counties. This deeper dive allowed us to mine new data for cross-regional comparison.

“The rigor around the design and analysis of this survey of Central Valley residents allows us to confidently draw conclusions about this population and how their health-related experiences and self-reported outcomes compare to those elsewhere in California.”

Principal Research Director

“The rigor around the design and analysis of this survey of Central Valley residents allows us to confidently draw conclusions about this population and how their health-related experiences and self-reported outcomes compare to those elsewhere in California.”

The rigor around the design and analysis of this survey of Central Valley residents allows us to confidently draw conclusions about this population and how their health-related experiences and self-reported outcomes compare to those elsewhere in California.

Though only 6.2 percent of Californians are uninsured—and more than a quarter (26.5 percent) are covered by California’s Medicaid program (Medi-Cal) and therefore should not have out-of-pocket costs—we found that Californians across all regions were skipping or delaying care due to high out-of-pocket health care costs and medical debt. About half of all residents (53 percent) and six out of 10 Central Valley residents (63 percent) reported postponing medical care due to high costs. More than one in three Californians (38 percent) and over half of Californians with low incomes (52 percent) reported having medical debt. 

Main Takeaways

  • Californians’ top health care priorities in 2023 were improving mental health treatment quality and access—with 86 percent of Central Valley residents and 81 percent of Californians overall citing its great importance—and reducing what people pay for health care (80 percent). 

  • More than half of Californians reported having problems finding a mental health care provider or making a timely appointment, and two in three said that improving the treatment of people with serious mental illness was critically important. 

  • Those with low incomes continue to be hardest hit by high out-of-pocket expenses, with nearly three out of four (74 percent) skipping or postponing care due to cost. Eight out of 10 low-income or Latin/x Central Valley residents also reported being “very” or “somewhat” worried about being able to afford out-of-pocket or unexpected health care costs. 

  • Access to care is a bigger challenge in the Central Valley than elsewhere in the state, with nearly one in four (23 percent) residents reporting a hospital closure in their community—four times that of other areas. Additionally, 78 percent of Central Valley residents were less likely to have a regular health care provider.  

  • Reviews were mixed regarding progress toward racial equity in health care. Unlike 42 percent of respondents who believe that the state has made either a “great deal” or “some” progress in bridging health care equity gaps, Black (44 percent) and Latino/x (33 percent) Californians say the state has made “only a little” or “no progress at all.” 

In a time of increasing climate instability, we also discovered that while 53 percent of Californians overall and 58 percent of Central Valley residents were worried about the weather and environmental factors on health, a much greater number of Spanish-speaking residents (82 percent) and people with low incomes (65 percent) were concerned about factors such as extreme heat, flooding, wildfires, and air quality on their own or a family member’s health.

NORC research gives voice to the voiceless.

Working with populations who are not typically the focus of research attention is both personally rewarding and critical to bridging health care equity gaps. Identifying and measuring disparities between Central Valley residents and those who live outside the region is the first step toward creating a more equitable health care system. A more equitable health care system is at the heart of our work in California. Our work for Covered California explores, among other topics, disparities between racial and ethnic groups with regard to health insurance coverage through its marketplace. One current Covered California project explores whether Medi-Cal enrollees have transitioned to other coverage—including via automatic enrollment into the lowest-cost marketplace plan—now that pandemic-era policies, which automatically renewed coverage for Medicaid beneficiaries, have ended.

Policy Implications

Our 2024 California Health Policy Survey findings yet again challenge the idea that having health insurance somehow guarantees affordability of care and access to it. As California’s policymakers and others review these insights—especially the new Central Valley data—and use them to tailor policies and programs, they may wish to pay particular attention to the impact financial pressures, such as the rising cost of living in California, are having on people’s ability to cover health care costs or willingness to enter into debt to do so.  

Read the Survey

Suggested Citation

Catterson, Rebecca Shore (2024, June 3). Being Insured Isn’t Enough to Get Californians to the Doctor. [Web blog post]. Retrieved from


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