Health Care Access, Experiences, and Concerns Since the COVID-19 Pandemic
This page provides an overview of Listening to Californians with Low Incomes. The complete report, including 27 figures highlighting key survey findings, as well as detailed data tables, is available under Document Downloads below.
Listening to Californians with Low Incomes
Between 2019 and 2021, CHCF funded a major research project to better understand the health care experiences, needs, and values of Californians with low incomes, including understanding changes during the COVID-19 pandemic. Learn what we learned by listening to Californians with low incomes.
The COVID-19 pandemic has inflicted significant stresses on the physical, emotional, and financial well-being of California’s residents, especially the seven million Californians — approximately 18% of the state’s residents — living in poverty.
CHCF partnered with NORC, a national research organization, to conduct a statewide survey of the health care experiences of California’s residents, age 18 to 64, who had received health care since March 2019. The survey included an oversampling of residents with low incomes.
The survey, conducted in the summer of 2020, asked respondents about their health care concerns, experiences, and access before and during the COVID-19 pandemic, as well as about their experiences with racial discrimination and the impact of the pandemic on employment and insurance coverage. This initial report highlights a collection of key findings from the survey, focusing on health care access, mental health, telehealth experiences, pandemic-related stresses, and experiences with racial discrimination. Findings are presented for respondents with low incomes (defined as below 200% of the federal poverty level) compared to respondents with higher incomes (defined as 200% FPL or higher) whenever sample sizes are sufficient to allow this comparison. In cases where there is an insufficient sample size, overall findings are presented.
The initial report, as well as a zipped file of all of the charts from the report, is available for download below.
The full report, to be released in early 2021, will detail complete findings on respondents’ experiences with health and health care since the pandemic, including analyses of differences by a variety of demographics (including additional analyses by income, race, ethnicity, and insurance coverage and new analyses by region, gender, and language) as well as cross-tabular analysis of the impacts of the COVID-19 pandemic on respondents.
Many Respondents Did Not Receive Wanted Care
A large portion of all respondents who reported wanting to see a physician or other health care professional since the start of the COVID-19 pandemic did not receive care. Notably, many respondents (31%) did not receive urgent or emergency care for a health problem unrelated to COVID-19.
Even larger shares of respondents did not receive care for a nonurgent physical health problem (45%) or mental health problem (44%).
Deterioration of Mental Health Since Pandemic Among Respondents with Low Incomes
Survey respondents with low incomes were also more likely to report that their mental or emotional health got “worse” (30%) or “a lot worse” (6%) since the start of the pandemic than did respondents with higher incomes (27% “worse,” 1% “a lot worse”). Survey respondents with higher incomes were more likely to report no change in their mental or emotional health (62%) compared to respondents with low incomes (44%).
Wide Access to Telehealth Among All Respondents
Telehealth was an important source of care for Californians who received care during the pandemic. Sixty-five percent of survey respondents with low incomes and 62% of respondents overall reported that they had a telehealth (phone or video) visit. Forty-three percent of respondents with low incomes reported having a phone visit, and 34% reporting having a video visit.
Three in four respondents of color (76%) who received care during the pandemic received a telehealth visit compared to less than half of White respondents (48%). Nearly equal percentages of respondents of color received care by video (47%) or by phone (46%).
Positive Experiences with Telehealth
Among survey respondents overall who received telehealth visits, satisfaction with them compared favorably to in-person visits. Among those who received care by phone, 24% of respondents overall reported they were “more satisfied” with their phone visit than with their last in-person visit, and 48% reported they were “just as satisfied.” Twenty-eight percent reported that they were “less satisfied” with their phone visit.
Among those who received care by video, one-third of respondents overall (33%) reported they were “more satisfied” with their video visit than with their last in-person visit, and one-third (32%) reported they were “just as satisfied.” Thirty percent of respondents overall reported that they were “less satisfied” with their video visit.
Respondents with Low Incomes Report Higher Levels of COVID-19-Related Stress
Concern about the health or well-being of a loved one was the most reported stress for respondents with low incomes and higher incomes, with over half of respondents (53%) experiencing this stress. Respondents with low incomes were more likely to report experiencing stress related to affording basic needs, such as food, rent, and utilities (50%), children out of school or childcare unavailable (38%), and the death of a loved one (10%) than respondents with higher incomes (18% for affording basic needs, 30% for childcare, 4% for death of a loved one).
Experience with Discrimination Common Among Black and Younger Respondents
The survey asked respondents a number of questions about their personal experiences with racial or ethnic discrimination and the impacts of any racial or ethnic discrimination on their health. Nearly 7 in 10 Black respondents (69%) reported ever personally experiencing discrimination or being treated unfairly because of their race or ethnicity. More than 4 in 10 Asian (43%) and Latinx respondents (43%) reported ever personally experiencing discrimination.
Younger respondents, especially those age 18 to 24, were more likely to report experiencing racial or ethnic discrimination (57%) than older age groups (25% to 41%).
About the Authors
This report was written by Jen Joynt, independent health care consultant. Research was conducted by NORC at the University of Chicago (NORC). NORC is an objective nonpartisan research institution that delivers reliable data and rigorous analysis to guide critical programmatic, business, and policy decisions. The survey and data analysis were led by Rebecca Catterson, MPH, senior research director at NORC and Lucy Rabinowitz, MPH, principal research analyst at NORC. For more information, visit www.norc.org.