Fewer Than Half of Americans Can Afford Quality Healthcare, Poll Finds

For the first time in five years of tracking, fewer than half of U.S. adults can consistently afford high-quality healthcare, according to a new West Health-Gallup Affordability Index poll released Thursday. Just 49% of Americans are now classified as “Cost Secure” — meaning they have access to quality, affordable care and can pay for needed treatment and medicine — down from a peak of 61% in 2022.

The findings, reported by the Associated Press, represent an estimated 2.8 million more Americans who dropped out of the Cost Secure category between 2024 and 2025 alone. The poll surveyed 5,660 adults from October through December 2025 and carries a margin of error of ±2.1 percentage points.

A Structural Decline in Affordability

The steady erosion of healthcare affordability represents a structural shift, not a temporary fluctuation. The percentage of Cost Secure Americans has fallen from 56% in 2021 — when tracking began — to 49% in 2025, a decline of 12 percentage points in four years.

According to Gallup’s full report, the Index divides Americans into three categories: Cost Secure (49%), Cost Insecure (41%) — those who lack access to quality, affordable care or cannot pay for care or medicine — and Cost Desperate (10%), who lack access and cannot pay for both care and medicine.

About 75% of U.S. adults said healthcare costs were a “major” or “minor” financial burden for their family, while only about 3 in 10 said costs were not a burden. Meanwhile, 51% of respondents said they were “extremely concerned” or “concerned” that their household would be unable to pay for needed healthcare services in 2026 — up from 42% in 2022.

Disproportionate Impact on Women, Minorities, and Young Adults

The affordability crisis cuts across demographics but hits some groups far harder than others. The gender gap in healthcare affordability has reached its widest point: 57% of men are Cost Secure compared with just 42% of women — a 15-percentage-point difference.

Racial disparities have also widened sharply since tracking began. Among White adults, 55% are Cost Secure, down 3 points since 2021. But among Black adults, only 38% are Cost Secure — a decline of 16 points — while just 32% of Hispanic adults are Cost Secure, a drop of 19 points.

Young adults aged 18 to 29 have experienced the steepest decline of any age group, with Cost Secure rates falling from 46% in 2021 to just 32% in 2025. Even seniors aged 65 and older — who are covered by Medicare — have seen a significant decline, from 73% to 61% over the same period.

Middle-Income Families Feel the Squeeze

The affordability crisis is not confined to low-income Americans. About one-third of households earning between $120,000 and $179,999 per year are not Cost Secure, and one in five households earning $180,000 or more also report struggling with healthcare costs.

Concern about affording prescription drugs has risen from 30% in 2021 to 42% in 2025. About 2 in 10 adults said there had been a time in the prior three months when they or a household member could not pay for prescribed medicine, and roughly 3 in 10 said they or someone in their household did not seek treatment for a health problem because of cost.

The Picture Is Likely Worse Than the Numbers Show

Crucially, the poll data reflects conditions before major recent policy changes took effect. The enhanced Affordable Care Act subsidies — first enacted in the 2021 American Rescue Plan Act and extended by the Inflation Reduction Act — expired on Dec. 31, 2025, causing insurance premiums to rise approximately 20% for middle-class families. Nationally, 21% of Healthcare.gov enrollees dropped coverage.

In early 2026, Congress also passed cuts to Medicaid, the government health insurance program for low-income Americans. These changes are expected to push millions more out of the Cost Secure category in the coming year.

Healthcare spending in the U.S. reached $5.3 trillion ($15,474 per person) in 2024, growing 7.2% from the previous year — more than double the 2.9% inflation rate. Hospital prices rose 3.4% in 2024, the fastest rate since 2007, while prescription drug spending rose 7.9%.

Human Toll: Delayed Care and Impossible Choices

For Americans like Twannetta Weaver, 43, of Sanford, Florida, the statistics translate into real hardship. Enrolled in a high-deductible health plan through her employer, Weaver slipped a disk in her back in 2025. The resulting medical bills forced her to delay graduation from a leadership degree program by a year.

“I had to start calculating, am I going to be able to afford to pay my tuition, as well as my books, as well as my living expenses, and continue to care for my family?” Weaver told the AP. “It makes you feel powerless as a consumer.”

What to Watch For

With the 2026 midterm elections approaching, healthcare affordability is emerging as a top voter concern. The data shows that women, younger voters, and racial and ethnic minorities — all key electoral constituencies — are disproportionately affected. However, the issue cuts across party lines, affecting voters across the income spectrum.

As the effects of the expired ACA subsidies and Medicaid cuts ripple through the system, experts warn that the share of Americans able to afford quality healthcare could fall even further. The next iteration of the West Health-Gallup Index, expected in 2027, will capture the full impact of these policy changes.