In this brief for the California Health Care Foundation (CHCF), authors use California Health Interview Survey (CHIS) data to better understand health care costs in California, including whether and how affordability may have changed between 2019 and 2024. They also use Current Population Survey (CPS) data in order to compare health care costs and affordability measures in California to the United States to see how those in California experience health care costs compared to the nation as a whole. 

For this analysis, four measures of health care affordability were studied — health insurance deductibles, medical bills, impacts of medical bills, and high-b urden spending — and tested for changes over time and between demographic groups.

Findings include:

• Problems Paying Medical Bills Declined in CA, Overall. The percentage of Californians who reported problems paying medical bills declined from 2019 (13.3%) to 2024 (11.8%).
• Statewide, Other Health Care Affordability Measures Held Steady. Medical bill impacts like having trouble paying for basic necessities (food, housing), taking out credit card debt to finance health care bills, and having bills larger than $4,000 were statistically unchanged from 2019 to 2024 looking at California as a whole.
• Percentage of People Reporting Large Deductibles Increased. 
• The share of Californians reporting large deductibles (of $2,000 or more) increased from 34.8% in 2019 to 37.8% in 2024—this increase was mostly concentrated in certain populations, including those with employer-sponsored insurance (ESI).
• Disparities Persist Across Measures by Income, Race/Ethnicity, Coverage Type, and Region. For example, Latino/x Californians reported trouble paying medical bills at higher rates than White Californians in 2024 (13.5% and 11.5%, respectively). Additionally, Latino/x and Black Californians reported higher rates of difficulty affording basic necessities due to medical bills than White Californians.