Special Series: Patterns of Delayed Healthcare Among New Yorkers with High Healthcare Need Over the Course of the Pandemic 

New York City’s high-need residents — those managing multiple chronic conditions, work-limiting health problems, or serious psychological distress — faced a healthcare access crisis that, rather than easing as the pandemic receded, shifted in nature and deepened along economic lines. New Poverty Tracker research from Columbia University, supported by Robin Hood and The Leona M. and Harry B. Helmsley Charitable Trust, tracked these New Yorkers from the pandemic’s height (2021) into its waning period (2022) and found that while COVID-19 itself became less of a barrier to care, economically disadvantaged high-need New Yorkers increasingly ran into affordability, insurance loss, and provider availability — obstacles that eased for their more-advantaged counterparts but persisted, and in some cases worsened, for those already struggling.

Key Findings:

The gap in delayed and forgone physical care nearly tripled as the pandemic waned: Economically disadvantaged high-need New Yorkers were 31 percentage points more likely to delay or forgo physical healthcare than more-advantaged New Yorkers in 2022 (47% vs. 16%) — up sharply from an eight-point gap in 2021 — even as more-advantaged New Yorkers saw their receipt of needed physical care jump from 66% to 84%.

Mental healthcare remained persistently out of reach, regardless of economic status: Forgoing mental healthcare was far more common than forgoing physical care for everyone — in 2022, 42% of economically disadvantaged high-need New Yorkers and 40% of more-advantaged high-need New Yorkers went entirely without mental healthcare they needed, compared to just 17% and 4%, respectively, for physical care.

The pandemic faded as a barrier, but cost and coverage stepped in to take its place: Among economically disadvantaged New Yorkers who delayed or forwent care, citing COVID-19 as the reason dropped from 54% in 2021 to just 19% in 2022, while the high cost of care (42%) and lack of insurance (20%, up from 13%) became the dominant obstacles — cost cited three times more often than by more-advantaged New Yorkers.

Insurance coverage eroded for the economically disadvantaged even as need stayed high: Economically disadvantaged high-need New Yorkers saw health insurance coverage drop eight percentage points over the pandemic (96% to 88%), while coverage among more-advantaged high-need New Yorkers stayed nearly universal (98% to 99%) — and disadvantaged New Yorkers continued to skip or delay filling prescriptions at more than double the rate of their peers (17% vs. 6% in 2022).

Real-world stories show how these barriers compound: First-person accounts — including a single mother in the shelter system who missed paid work to keep specialist appointments she couldn’t reschedule, and a woman with HIV who delayed a needed procedure for nearly three years and was later left with a $15,000 medical bill despite having Medicaid — illustrate how affordability, insurance instability, and provider shortages combine to keep high-need New Yorkers from getting care even when they’re actively trying to access it.