MENLO PARK, CA – As economic conditions continue to worsen, the public is increasingly worried about the affordability and availability of care, with many postponing or skipping treatments due to cost in the past year and a notable minority forced into serious financial straits due to medical bills, according to the Kaiser Family Foundation's first health care tracking poll of 2009.

In the face of the country's current economic challenges, the public's support for health reform remains strong and their trust in President Obama to do the right thing in health care reform is high.

Slightly more than half (53%) of Americans say their household cut back on health care due to cost concerns in the past 12 months. The most common actions reported are relying on home remedies and over-the-counter drugs rather than visiting a doctor (35%) or skipping dental care (34%). Roughly one in four report putting off health care they needed (27%), one in five say they have not filled a prescription (21%) and one in six (15%) say they cut pills in half or skipped doses to make their prescription last longer (see chart).

"Experts and policymakers have multiple agendas in health reform, but when half the public reports skimping on care because they can't afford it, it's very clear that what the public wants most from health reform is relief from health care costs," said Kaiser President and CEO

The 27 percent of the public that reported they had "put off or postponed getting health care [they] needed" were asked about the specific types of care they had foregone. The most common responses were delaying going to the doctor for a temporary illness (19%) or for preventive care (19%). But nearly as many -- 16 percent -- report putting off care for a more serious problem, either postponing a doctor's visit related to a chronic illness such as diabetes or delaying major or minor surgery.

Not all medical care can be postponed, however, and the survey indicates that roughly one in five (19%) people experienced serious financial problems recently due to family medical bills. Specifically, 13 percent say they have used up all or most of their savings trying to pay off high medical bills in the past 12 months, and just as many say their medical debt means they have difficulty paying other bills. A similar proportion (12%) say they have been contacted by a collection agency, while a smaller share (7%) report being unable to pay for basic necessities like food, heat or housing.

Beyond actual financial hardship due to medical care, the survey also indicates a rise in worries associated with health care costs. Nearly half of Americans (45%) report they are "very" worried about having to pay more for their health care or health insurance, the highest proportion measured in Kaiser polls since late 2006. Roughly four in 10 (38%) are very worried about affording health care they need -- a number that rises to 56 percent among those who believe someone in their household will lose a job this year.

Fully one-third (34%) of those with health coverage are worried they will lose it. While these concerns are prevalent among low-income Americans, one-third of households earning between $30,000 and $75,000 per year are also "very worried" about losing their health care benefits.

Support for Action on Health Care Reform Strong, But High Expectations Pose Challenge

The share of Americans who say that the country's economic problems make it more important than ever to take on health care reform has remained remarkably stable over the past five months at roughly six in 10 (62%). However, the partisan divide also remains large with Democrats overwhelmingly (79%) saying reform is more important than ever and most Republicans (58%) saying the nation cannot afford to tackle health care reform at this point. Independents tilt the balance by being in favor of reform now (57%).

Health care continues to rank as one of the top issues on the nation's policy agenda. The economy dominates (71%) the public's priorities for the president and Congress, followed by making Medicare and Social Security more financially sound (49%) -- a new issue added to the list this month. Terrorism (42%) and health care (39%) rank third and fourth.

Interestingly, while the majority of Americans view action on health reform as more important than ever and believe reform would be good for the country as a whole (59%), fewer think it would personally benefit them or their family (39%). A plurality (43%) of Americans do not expect to be personally impacted by reform and a small minority (11%) think they would be worse off.

"Far more people see themselves directly benefiting from health reform and far fewer see themselves being negatively affected than we saw in the Clinton health reform debate. Today's economic anxieties have created a better starting point for health reform than we saw last time around," said Dr. Altman.

While health reform remains popular, the public has high expectations for how easily reform might be achieved. A majority (58%) of Americans say that if policymakers made the right changes, they could reform health care "without spending more money to do it." This majority view is shared across political party identification, age group and income level. A majority (56%) of the public also believes that the health system can be reformed "without changing the existing health care arrangements of people like yourself."

Seven in 10 Americans (72%) have a "great deal" or "fair amount" of trust in President Obama "to do or recommend the right thing for health care reform," giving him a 12 percentage point lead over the next most trusted actor in health care reform. Following Obama on the list of trusted players are doctors' organizations (60%), Democratic leaders in Congress (57%) and AARP (57%).

When Americans hear policymakers talk about health care reform, they predominantly are thinking about cost and coverage. When asked what "health care reform" means to them, 40 percent of the public respond with a cost concern -- people paying less for care, care being more affordable or lowering the prices of medical goods such as prescription drugs. Just as many (39%) describe reform as providing insurance to more people or helping the uninsured. Quality or delivery system reform did not leap to the minds of Americans with only nine percent mentioning it in their responses.

Methodology

The survey was conducted February 3 through February 12, 2009, among a nationally representative random sample of 1,204 adults ages 18 and older. Telephone interviews conducted by landline (903) and cell phone (301, including 123 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.