Correction: data for small group actuarial value in figure 8 was corrected February 8 2024.

Executive summary

Consumer health care affordability has deteriorated over the past two decades in California due to rising premiums along with increasingly common and increasingly large deductibles for job-based coverage. Taken together, these trends in premium and deductible growth result in health care taking up a larger and larger share of household income. This has consequences for Californians’ health and financial well-being: a significant portion of California adults—with any type of insurance including those without insurance—reported that in the last 12 months they or a family member had delayed or postponed care due to cost (52%), had problems paying or couldn’t pay any medical bills (27%), or had some type of medical debt (36%).

The California Office of Health Care Affordability (OHCA) is tasked with controlling the growth in per capita spending on health care and ensuring that consumers benefit from this reduction in the rate of growth. To these ends, we suggest OHCA monitor consumer affordability metrics related to the cost of coverage, the cost of care, and the consequences of unaffordable coverage and care for both health and financial well-being. There are two types of sources for these data: administrative data sources that can be used to annually assess consumer affordability; and survey data that can be used to investigate and monitor longer-term trends and equity impacts. OHCA has access to existing, state-specific data sources and more can be developed over time. OHCA should monitor trends and report on consumer metrics in their annual reports, starting with statewide trends in the 2025 baseline report and as part of annual reports thereafter.

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