Long Islanders skipping some medical procedures due to high cost, survey says

Nearly 6 in 10 Long Islanders went without health care at least once in the prior year because they could not afford it, and nearly 2 in 10 did not fill a prescription or rationed medicine to save money, a newly released survey found.

Twenty-two percent of Long Islanders experienced medical debt or another "medical cost burden," such as borrowing money or cutting down on food or other necessities, according to the survey, released Wednesday by the Manhattan-based nonprofit Community Service Society of New York. 

Long Island is a primarily middle-class region, but that doesn’t protect residents from the effects of burgeoning medical costs, said Elisabeth Benjamin, the society’s vice president of health initiatives.

"This survey shows an incredible burden on middle-income people," she said.

The statewide survey of 1,397 residents of Long Island, New York City and upstate was conducted in late December and early January.

Median household income in Nassau, $141,568, and Suffolk, $124,045, were far above the $82,095 statewide median, according to 2023 Census Bureau estimates.

But the region also has the highest hospital costs in the state, and New York has the second-highest health care costs and insurance premiums in the country, Benjamin said. That, combined with the increasing number of high-deductible insurance plans with large co-payments, makes it difficult even for people solidly in the middle class to afford health care, she said.

The high cost of living on Long Island means money doesn’t go as far, and a medical emergency can be financially "devastating" to a family, said Vanessa Baird-Streeter, president and CEO of the Health and Welfare Council of Long Island.

Residents often skip mammograms, colonoscopies and other procedures that can prevent serious illness or death, she said.

Those with medical debt in particular are less likely to seek additional care, Benjamin said.

"If you have diabetes and you have medical debt and your toes start feeling numb, you may not go back and get the treatment you need to prevent having a full leg amputation," she said.

Benjamin traces many of the problems to state health care deregulation in the 1990s that ended price controls.

Large health systems generally charge more than smaller ones, so the trend toward more hospital acquisitions and mergers is helping drive up prices, she said. A service society analysis of data from the California-based research organization RAND found that commercial insurance companies paid much more to hospitals that are part of the six largest health systems in New York than to other hospitals. The insurance payments are a reflection of how much those systems' hospitals charge patients.

That especially affects Long Island, where New Hyde Park-based Northwell Health, the state’s largest health system, dominates, Benjamin said. Three of the other largest health systems also have hospitals on Long Island: Catholic Health Long Island, Mount Sinai and NYU Langone Health.

Wendy Darwell, president and CEO of the Nassau-Suffolk Hospital Council, said last year’s state budget increased the amount of free or discounted care that hospitals must provide and took other steps to reduce financial burdens on patients.

"You need to give them a chance to be implemented," she said.

Darwell said a key problem for hospitals, which in New York are required by law to be nonprofit, is that Medicare and especially Medicaid reimbursements are far below hospitals’ costs to care for patients. That shifts more of the burden to people with private insurance, she said.

A Republican proposal that narrowly passed the House Feb. 25 to cut $880 billion in Medicaid, Medicare or child-health funding, or a combination, over 10 years would shift even more costs to commercial insurance, Darwell said.

Northwell spokeswoman Barbara Osborn said in a statement that the health system had provided $287 million in charity care in 2024 and touted an agreement with Attorney General Leticia James reached in June in which, James’ office said, Northwell increased eligibility for free or discounted care to families with annual household incomes of up to five times the poverty level. But Osborn Friday claimed that eligibility had been in place "for more than a decade."

Northwell, Osborn said, believes "health care should be affordable for all regardless of their ability to pay."

Darwell said hospitals try to help patients who have trouble paying their bills.

Baird-Streeter, whose organization partners with the society to help consumers navigate the health care system, recalled how the council recently worked with a hospital to reduce a Nassau client’s medical debt from $38,000 to $5,000. The client was avoiding medical care for fear of more debt but now is back to seeing the doctor, she said.

Baird-Streeter said patients also should not accept an insurance company decision they think is unfair as final.

"If you receive a denial, don’t just accept that denial," she said.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.