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This story is part of The Salt Lake Tribune’s ongoing commitment to identify solutions to Utah’s biggest challenges through the work of the Innovation Lab.

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Two hours in the emergency room last year racked up a $4,500 bill that Amanda DeBry expects will take years to pay off.

Though Debry, a 29-year-old living in West Valley City, got her monthly payment for two bills down to a combined $100, there have been some months where she’s been short at the end of the month.

She’s experienced chest pain since but has put off getting it checked out because she’s worried about more bills she can’t afford.

DeBry is far from alone.

Nearly 70% of Utahns surveyed earlier this year experienced at least one health care affordability burden in the previous year. Burdens include going without insurance because of high costs, delaying or going without health care because of the expense, skipping or rationing increasingly costly prescriptions and struggling to pay medical bills.

That’s up from 27% in 2020, according to Healthcare Value Hub, the organization that published the survey results.

The group did a deep dive into health care affordability in individual states this year and gave Utah 32.4 out of 80 points — the equivalent of an F.

Utahns’ opinions of health care costs are similarly pessimistic — 86% worry about affording health care in the future. That’s higher than a recent national survey that found 67% of respondents worry about affording health care.

State leaders have taken some “critical” steps to help, the report says, but “generally performs poorly on a suite of measures across many health care affordability domains.”

Among the recommendations from Healthcare Value Hub is exploring a cost growth benchmark — something the One Utah Health Collaborative is working toward along with other initiatives to address health care spending — and strengthening the state’s price transparency tool.

One Utah Health Collaborative has been working on affordability since September 2022, and big change will take time but is crucial, said Executive Director Jaime Wissler.

“It’s indefensible, and something really needs to be done,” Wissler said of rising health care costs.

And Gov. Spencer Cox described addressing health care costs as “an economic imperative” in a signing event for the collaborative.

Costs ‘affecting people across the board’

The survey, conducted by Altarum and published by Healthcare Value Hub, polled more than 1,300 Utah adults between May 18 and June 3, 2023.

It found that 69% of respondents experienced at least one health care affordability burden in the past year and 86% worry about future health care costs.

Daniel Sloan, a health policy analyst with the Utah Health Policy Project, said that isn’t surprising, especially because of prescription drug costs and other factors “affecting people across the board.”

While people making $100,000 or more were less likely to experience issues with affordability, more than half still had some cost burden in the previous year.

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That percentage increased in lower income ranges, and people making less than $100,000 a year also were more likely to go without care and ration or skip medication.

People making more than $75,000 but less than $100,000 a year were the most likely to incur debt, deplete their savings or skip basic needs because of health care costs.

There was virtually no difference between respondents living in rural areas and people living in urban or suburban areas.

White people were less likely than people of color to worry about affordability or experience issues affording health care, and people identifying as Hispanic or Latino were the most likely to worry or experience issues.

Households in which at least one person has a disability also were more likely to worry than households where no person has a disability.

Issues with affordability include 51% of respondents without insurance saying they skipped coverage because it was too expensive.

Sloan describes that figure as “alarming,” especially as thousands of Utahns are losing Medicaid coverage, leaving more people in a gap where they don’t have anywhere to go.

More than half of respondents said they had delayed or gone without health care in the past year because of high costs, including:

• 42% skipping needed dental care

• 42% delaying a doctor’s appointment or procedure

• 37% skipping a recommended test or treatment

• 37% avoiding a doctor’s appointment or procedure altogether

• 35% cutting pills in half, skipping doses of medication or not filling a prescription

• 29% experiencing issues getting mental health care or substance use treatment

• 29% skipping needed vision services

• 17% skipping needed hearing services

• 15% skipping or delaying getting a medical assistive device

DeBry has experienced chest pain about once a month since her ER visit a year or so ago but has put off going to get it checked. She thinks the issue may be gallstones and is looking for a gastroenterologist now that insurance kicked in with another new job. But she still has worries.

“There’s part of me that’s nervous that they still don’t know what’s going on,” she said, adding she’d end up with more bills anyway.

As people delay all types of health care because of costs, a lot of “pretty avoidable issues” are popping up, Sloan said.

Finally, 45% of respondents said they struggled to pay medical bills, with:

• 21% using up all or most of their savings.

• 18% getting sent to collections.

• 15% going without basic necessities like food, heat or housing.

• others racking up debt, borrowing money or going on a long-term payment plan.

DeBry hasn’t gone without food or housing, but she has had to pay less on her medical bills some months and tack on extra with a follow-up payment. She’s also gotten notices from medical creditors and called to let them know the rest of the payment is coming.

She plans to use some tax refund money to help pay off more of the bills but said whatever she gets back likely won’t be enough to cover all of the debt.

“It’s a huge stress,” DeBry said. “One visit like this can really upend your whole life.”

She’s grateful the bill was less than $5,000 but said it will take years to pay off unless she comes into a big sum of money.

Thousands turn to crowdfunding, get help from charities

The survey results didn’t mention turning to charity or crowdfunding for options, but more and more people are doing so.

Thousands of Utahns started fundraisers on GoFundMe this year asking for help covering medical expenses, according to a company spokesperson.

Reasons run the gamut, from rare medical conditions to injuries from ATV crashes and heart transplants to cancer.

GoFundMe fundraising also reflects the impact of people seeking deferred treatment, the spokesperson added in a statement, with a 20% increase in cancer-related fundraisers.

RIP Medical Debt also helps wipe out debt by buying it bundled for a fraction of the cost and forgiving it. It’s one of a few nonprofits focused on helping people tackle medical debt.

One campaign in Utah funded by Orem-based Nomi Health wiped out $42 million in debt for more than 10,000 people in 2021, said Scott Patton, vice president of development for RIP Medical Debt.

The nonprofit consistently has access to middle to upper-middle levels of debt in Utah compared to elsewhere, Patton said. The organization abolishes what it can access, he said, and then the debt replenishes within a few months.

RIP Medical Debt sends letters to recipients letting them know that particular accounts are taken care of, Patton said.

People who respond write they’re overwhelmed and have restored hope, he said.

“We are addressing a very important financial issue, but we’re also addressing a mental health issue that is unfortunately a very real consequence of our medical system,” Patton said.

It affects more than just mental health through stress and anxiety, he said, and is also a physical health issue. Medical debt is a social determinant of health because people stop going to get treatment when they have a lot of it, he said.

Widespread support for change

Americans and Utahns want the system to change.

Reducing health care costs remains a top concern for voters nationwide, coming in just behind the economy in a Pew Research Center poll earlier this year.

More than 75% of respondents to the Altarum survey think the government needs to do something about health care costs, and some actions received up to 93% support.

That includes 81% support for setting growth targets on health care spending. Eight states — including the western states of Oregon, Washington and Nevada — already have set growth targets to slow the increase in spending.

And Utah is working on setting a cost growth target by consensus instead of through legislative action. It would be the first red state to do so, said Wissler, of the One Utah Health Collaborative.

Healthcare Value Hub recommends Utah also look at other policies, including establishing an affordability index, strengthening the price transparency tool by publishing price ranges, focusing on Medicaid and marketplace outreach and other strategies to improve uninsured rates and broadening protections when people get surprise medical bills.

Survey results show widespread support for other government actions too, including moves to require up-front cost estimates from insurers and providers, cap out-of-pocket costs for insulin and other lifesaving drugs and indicate a fair price for specific procedures.

People tend to look to the government because “patients are often so powerless,” said John Poelman, the collaborative’s director of innovation.

But some of the actions people supported in the Altarum survey don’t have to come from the government, he said.

In addition to looking at a cost growth target, the collaborative has other initiatives ongoing or to follow, including a digital pilot to help reduce waste, Wissler said. The group is accepting community ideas.

The collaborative also is highlighting success stories like Civica Rx. The Lehi-based nonprofit manufactures generic versions of dozens of commonly used medications for 1,600 hospitals across 55 health systems. It recently announced it would start manufacturing and distributing low-cost insulin.

One Utah Health Collaborative’s efforts have “a lot of potential for being a convening force,” said Sloan with the health policy project.

One of the reasons it’s so hard to change the health care system is that there are so many stakeholders with lots of vested interest, he said. Getting everyone at the table is a good first step, he added.

Poelman is optimistic on that front.

The coronavirus pandemic showed that Utah’s health systems can work together, he said, and they can make a team effort again.

Megan Banta is The Salt Lake Tribune’s data enterprise reporter, a philanthropically supported position. The Tribune retains control over all editorial decisions.