Whether or not our health care system works well for you could depend on your income level, according to a new national survey. The study, "Life Experiences and Income Inequality in the United States," was released by National Public Radio, the Harvard T. Chan School of Public Health Chan, and the Robert Wood Johnson Foundation. According to the survey, income inequality has a significant effect on Americans' feelings about financial security, and on their attitudes towards things like health care, education, and other common life expenses.

In the area of health care, the report found that nearly half of middle-class Americans (48 percent) have experienced serious problems paying for medical bills, dental bills or prescription drugs. For lower-income Americans, that number is close to two-thirds (57 percent). Only 8 percent of the top 1-percent earners say they have had problems with health-related bills.

Inequality in many areas—but especially health care

The first part of this series discussed the survey's findings in areas such as unexpected expenses, housing costs, and credit card debt. In all cases, wealthier Americans expressed fewer problems and less anxiety about dealing with such financial challenges. Although low-income Americans expressed the most financial stress, a relatively high number of middle-class households also said they have struggled with common financial burdens.

With health care, the gap is more pronounced. When asked about specific areas of health care, middle-income and low-income Americans clearly have different experiences than do the wealthiest Americans.

When asked if they have had serious trouble paying medical bills in recent years, 5 percent of the wealthiest one percent ($500,000+ in yearly income) said yes, and 18 percent of high-income Americans ($100,000 to $499,999) agreed. That number jumped to 31 percent for middle-income Americans ($35,000 to $99,999). Thirty-eight percent of lower-income Americans ($35,000 or less) said they had serious trouble paying medical bills in the past few years.

Timeliness of health care was also a problem, depending on your income. The survey found that 31 percent of lower-income Americans said they had serious problems getting health care when they needed it; 26 percent of middle-income respondents had problems with access. The numbers were 15 percent for higher-income respondents and 7 percent for the highest-income Americans.

Troubling numbers on prescription drugs

Prescription drugs also are more of a concern for less-wealthy Americans. Only five percent of the wealthiest Americans said they have had serious problems paying for prescriptions, but for other Americans the numbers were 16 percent for higher-income respondents, 22 percent for those with middle-incomes, and 31 percent of those in the lower-income range.

More concerning numbers were found in a similar area: respondents with health insurance who were told a drug was not covered by their plan and ended up not filling the prescription. Although an income gap is also seen here, it is notable that Americans of all levels reported this problem in higher percentages: it happened to highest-income Americans 18 percent of the time, 41 percent of the time with higher-income respondents, 48 percent of the time with middle-income respondents, and 51 percent of the time with lower-income Americans.

"More than three in ten adults across all income groups who have prescription drug coverage say they or household members have been told their health insurance plan would not cover a drug prescribed by their doctor in the past year," the report noted.

General agreement on government's role in health care access

One area of the survey showed relatively high numbers of Americans in agreement: namely, the idea of universal access to health care coverage. Survey respondents were asked if they thought it should be very or somewhat important for the President and Congress to make sure that all Americans have health insurance coverage.

The result shows the numbers did not vary by much. Of the top 1-percenters, 72 percent said this was somewhat or very important (28 percent said not important); 73 percent of higher-income Americans said it was somewhat or very important (26 percent said not important); 72 percent of middle-income respondents said it was very or somewhat important (25 said not important). Not surprisingly, lower-income Americans showed more support for universal coverage; 87 percent said the government should make sure everyone is covered (12 percent said it was not important).

The groups conducting the survey said the results underscored the growing concern about income inequality in the United States. ""It is simply unacceptable in a country as wealthy as ours that so many people lack sufficient income to pay for health care, housing, or even food," said RWJF President and CEO Rich Besser. "We need to address income inequality if we truly want everyone to have a fair and just opportunity to live the healthiest life possible."

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The other America: Health care leads the way in perceptions of inequality

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