AMERICA'S ECONOMIC AND HEALTH CARE CRISES have formed a perfect storm battering working families.

The results of the online 2009 Health Care for America Survey, sponsored by the AFL-CIO and Working America, reveal deep problems that must be fixed. A total of 23,460 people responded to the survey, which was conducted between April 1 and May 31, 2009. And more than 6,000 people took the time to tell heart-wrenching stories about the toll of health care costs, lack of insurance, systemic flaws in our health care system and the economic downturn.

The survey confirms that every day, people are being forced to make life-and-death decisions: Pay the health care premiums or buy the life-saving prescription? Chip away at credit card debt or skip the required care for a serious chronic condition? Nearly everyone is dissatisfied with health care costs—including almost three-quarters of people with insurance. As one woman wrote, "My insurance deductible equals four to five months of take home pay each year. My insurance bill is split with my employer but equals two days of pay each month. How am I supposed to go to a doctor?"

As this survey report was being prepared, congressional committees were writing health care reform legislation. The AFL-CIO will share these results with members of Congress and the administration, as well as the media and state and local leaders. From the extensive survey responses—and even more poignantly, from the personal stories—policymakers will learn about the everyday impact of our disintegrating health care system.

Congress and the administration must hear that health care reform is urgent. First, people need relief from the pressure of untenable health care costs that are bankrupting families, endangering health and hobbling businesses. Second, the insurance system is failing working families. The public is extremely dissatisfied and demanding change. Survey respondents overwhelmingly support stronger rules and standards for insurance companies and a public health insurance option for those who choose it. Many people who submitted stories went further, calling for a single-payer health care system.

Among the survey's findings:

• High and rising health care and insurance costs are keeping people from getting needed health care. More than half say they cannot get the health care they need at a price they can afford, and the problem is
  even more acute among people who buy their own insurance,
  Hispanics and young adults.

• A third of all respondents forgo basic medical care because of costs. More than one-quarter of people with insurance—and three-quarters of those without insurance—report skipping basic health care services such as doctor-recommended tests and treatments and visiting a doctor when sick.

• Having health insurance does not shelter families from high costs or difficulty getting care. Fully 43 percent of people with insurance say they are not able to get the care they need at a price they can afford. And 80 percent of those with insurance say their health care costs increased this past year, with 34 percent saying they increased a lot.

• As the economy has worsened, health care has been lost along with jobs. Nearly a quarter of respondents say someone in their household lost health care coverage in the past year because of losing or changing jobs.

• Once health care disappears, it's hard to get back. One-quarter of those without health insurance say they were denied coverage in the past year due to "pre-existing conditions."

• Health care is costlier and harder to access for people who cannot get employer-provided coverage or Medicare and buy insurance in the private market. Sixty-two percent of them say they cannot get the care they need at an affordable price, compared with 39 percent of people with employer-provided coverage.

• The uninsured are in a dire situation, with 96 percent saying they cannot get the care they need at an affordable cost.

• Three-quarters of our respondents (76 percent) are dissatisfied with their household's health care costs. Two-thirds are dissatisfied with their health care coverage. More than one-third are dissatisfied with their household's access to care and the quality of care they receive.

• Ninety-seven percent of people who took the survey, including 96 percent of those with insurance, say that given the current economic crisis, health care reform is urgent.

• By far, most people (83 percent) say health insurers have too much influence on their health care and treatment.

Today's Health Care System Is Failing Working Families

The 2009 Health Care for America Survey makes clear that today's health care system is not working. It costs too much. Too many people are uninsured and even those with insurance report serious problems affording needed care. Survey respondents are deeply dissatisfied with health care coverage as well as costs, and tell horror stories about insurance companies refusing coverage and denying and delaying payments—sometimes until an illness has taken the ultimate toll. In an economic crisis, getting, maintaining and paying for health coverage and health care are major concerns.

High and Rising Costs Are Keeping People from Getting Care They Need

More than half (52 percent) of respondents say they cannot get the health care they need at a price they can afford.

The uninsured, Hispanics, households in economic trouble, young adults and single people find it particularly hard to find affordable care they need.

Most people without insurance—and a significant proportion of those with insurance—report skipping needed medical care due to costs.

Costs Push People to Skip Care—Especially the Uninsured

In addition to the uninsured, people in financial straits, Hispanics and young adults are more likely to say they've skipped needed medical care because of costs.

Young Adults, Those 'Falling Behind' and Hispanics Also Skipping Care Due to Costs

Crucial Health Care Treatments Are Not Affordable for a Quarter to More Than One-Third of Respondents
Are any of the following health expenses not affordable for you today?

Sixty-seven percent spent more than $1,000 out of pocket in the past year. Almost half of people had out-of-pocket health care expenses of between $1,000 and $5,000 in the past year, with one in five reporting out-of-pocket
costs of more than $5,000.

And 79 percent say their health care costs increased some or a lot in the past year.

Eighty percent with insurance say their health care costs increased this past year, with 34 percent saying costs increased a lot.

Worry runs deep about problems paying for health care. More than three-quarters (78) percent are somewhat or very worried. Nonunion households are especially concerned (52 percent are very worried; 30 percent are somewhat worried).

With rising costs and growing worries, it's no surprise that survey respondents describe deep and broad dissatisfaction with our health care system today. Large majorities are dissatisfied with costs and health care coverage—and more than a third are dissatisfied with access to care and health care quality.

• More than three-quarters (76 percent) are dissatisfied with their household's health care costs and two-thirds (66 percent) are dissatisfied with coverage.

• More than one-third of respondents are dissatisfied with their household's access to care (36 percent) and the quality of care they receive (35 percent).

Dissatisfaction with health care in America overall is even greater than the dissatisfaction reported about respondents' own household situations.

Health Insurance Is Not a Shield

Having insurance is no shield against problems and concerns.

• Almost one in four (23 percent) of those with insurance say their insurer refused to pay for doctor-recommended treatments or tests in the past year. Even more (27 percent) report their insurer denied a claim they felt should have been covered.

• Forty-one percent also report that their insurer paid less than it should have for a claim in the past year.

• More than two-thirds with insurance worry about their households losing insurance, and almost three-quarters worry about their households being able to pay for health care.

Concern about losing health coverage is widespread.

• Seventy-one percent of those surveyed are somewhat worried (31 percent) or very worried (40 percent) that someone in their household will lose health coverage in the next year.

• Even among those with employer-based health insurance, 67 percent are at least somewhat worried about losing coverage.

Concern about health care is even greater when people think about changing jobs.

People Who Buy Their Own Coverage Fare Worse

Although having insurance does not resolve working families' health care problems, people who have to buy their own insurance in the private market are less able to afford the care they need and report greater cost increases than those with employer-provided insurance or Medicare.

...Are More Likely to Skip Needed Care...

...And Their Costs Are More Likely to Have Increased
a Lot
How have your health care costs changed over the past year?

People who buy their own insurance also are more likely to be dissatisfied with their coverage.

Union household members and married people are more likely to have employer-provided health coverage.

Economic Collapse Tied to Health Care Crisis

The health care crisis is exacerbating—and exacerbated by—the effects of the most severe economic collapse in a generation.

• The economic downturn has affected 63 percent of respondents' households—43 percent say it has affected them quite a bit and 20 percent say it has affected them very much.

• When it comes to finances, only 12 percent surveyed say they are getting ahead, while 88 percent say they have just enough to get by (56 percent) or are falling behind (32 percent). The differences between the getting ahead and falling behind rates by education and race/ethnicity are relatively small, but people who are single and those who buy their own health insurance are much more likely to be falling behind than married people and those with employer-sponsored health coverage.

• In the past year, one of four (24 percent) surveyed say someone in their household lost health care because of losing or changing jobs.

Health Care Reform Is Urgent

The survey respondents nearly universally agree that health care reform is urgent.

People Overwhelmingly Want Government Standards, Cost Limits and a Public Health Insurance Option
Which statement comes closer to your way of thinking?

Who Took This Survey?

The troubling results of this survey are especially notable because the people who responded to it should be doing quite well. Sixty-four percent are employed and 20 percent are retired. Seventy-eight percent are insured. Fifty-seven percent are in union households. More than 80 percent have attended at least some college. Fifty-six percent are married and 52 percent are 50 to 64 years old.

The experiences of these 23,460 people and the personal stories from more than 6,000 of them are a telling signal of the failure of America's health care system.

About This Survey

The online 2009 Health Care for America Survey was conducted between April 1 and May 31, 2009. A total of 23,460 people submitted responses to the survey and 6,409 submitted personal stories.

The survey was featured on the AFL-CIO website, and more than 25 organizations promoted the survey through links and e-mails. These include eight national unions (AFGE, AFSCME, AFT, BCTGM, IBEW, NEA and USW); our community affiliate and survey co-sponsor Working America; eight state labor federations and local labor councils; the constituency group Pride at Work; and allied organizations including American Rights at Work, Jobs with Justice, Union Privilege, Health Care for America NOW, PHI: Health Care for Health Care Workers, the Universal Health Care Action Network and the Northwest Federation of Community Organizations.

To e-mail survey results to a friend, download a PDF of the report or read personal stories, visit www.2009healthcaresurvey.aflcio.org.