WASHINGTON — Twanetta Weaver felt she was making a responsible choice when she enrolled in a high-deductible health insurance plan through her employer. This allows them to avoid high premiums and save for retirement.
Then, in 2025, she slipped a disc in her back, requiring medication and physical therapy. Weaver, who had been working on a leadership degree in addition to her adult studies, had to delay her graduation by a year due to sudden medical bills.
“I had to start doing the math. Am I going to be able to pay my tuition, my books, my living expenses and continue to take care of my family?” the 43-year-old Sanford, Fla., resident said in an interview. “It makes you feel powerless as a consumer.”
Weaver’s experience is familiar to a growing number of Americans, according to new data from the West Health-Gallup Affordability Index, which shows that only about half of U.S. adults could afford health care and had access to quality care last year. Concerns about paying for health care next year are at an all-time high since the survey began in 2021, indicating that many people are worried about rising health costs as 2025 ends.
The new findings released Thursday are based on research conducted from October to December 2025, before major recent health policy changes went into effect, including Congress’ Medicaid cuts and the decision not to extend Affordable Care Act subsidies. It shows how the country’s strained health care system is straining Americans as midterm elections approach and affordability concerns become top of mind as inflation drives up costs.
Americans are worried they won’t be able to pay their medical bills.
The index used responses from multiple questions to classify Americans into three categories based on their access to quality care and ability to pay for care and medications. New data shows 49% of U.S. adults are considered “cost-safe.” This means they have access to high-quality, affordable care and can afford the care and medications they need these days. In 2021, when measurements began, 56% of U.S. adults said they were “cost confident.” It rose to 61% in 2022, but has been declining ever since.
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The survey found that nearly three-quarters of U.S. adults say medical costs are a “major” or “minor” financial burden for them and their families. Only 3 out of 10 people said it was not a burden.
Meanwhile, about half of respondents say they are “very concerned” or “concerned” that their household will not be able to pay for needed health care services in 2026, up from 42% of respondents who said so in 2022.
Inger Perez, 59, of Encino, Texas, is one such worried American. She has a family history of diabetes, hypertension, and cancer. She says she recently had a blood test done and would like to know the results, but is bracing herself for what the results will show.
“I literally cried last night. I was anxious and anxious about what we were going to find out and how much care it would take and how much money it would cost,” she said in an interview. “I’m worried that even if I start a treatment plan, I won’t be able to afford to continue it.”
More than half of survey respondents said that medical expenses contribute “a lot” or “somewhat” to the stress in their daily lives. By comparison, these costs equate to 3 in 10 people who say they’re not stressed at all, and 2 in 10 who say they’re not at all stressful.
Perez said she is also dissatisfied with the quality of care she receives, especially since she lives in a rural area about an hour from the clinic. Her budget required her to choose a lower-cost Affordable Care Act Marketplace plan with a limited network of eligible providers, another barrier to finding the right care.
Health care affordability is declining across demographics
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According to the findings, several groups of Americans who will see declines in health care affordability and access in 2025 include younger people, older adults, and women.
Only about a third of Americans under 30 are classified as “cost-safe,” down from 46% in 2021. Women were already less likely than men to be “cost-safe,” but that gap widened last year. In the 2025 survey, about 57% of men said they were “confident about costs,” down from a high of 67% in 2022, compared to 42% of women.
Older Americans, most of whom are enrolled in the government’s Medicare health insurance program, generally tend to have more “cost security.” However, this group also saw a significant decline, from 73% in 2021 to 61% in 2025.
Patients make sacrifices to pay the bills
Several survey respondents who spoke to The Associated Press spoke about things they had to give up to pay for their medical bills.
In a 2025 poll, nearly 2 in 10 U.S. adults said there was a time in the past three months when they or someone in their household was unable to pay for a medication prescribed by their doctor due to cost. About 3 in 10 people said they or someone in their household did not receive treatment for a health problem because of the cost.
Xavier Chapa, a 55-year-old father in Arizona, said his wife of 50 years is fighting with her insurance company over a preventive colonoscopy recommended by her doctor.
He said the company verbally promised compensation, but did not honor it after the process was completed.
A looming $3,000 bill means she has had to cut her 8-year-old son’s summer camp schedule from a full-day to a half-day program and cut other parts of her budget.
“There’s a lot to deal with,” said Chapa, who returned to the United States from Europe three years ago. “What’s the point of living in this country if you have to pay so much money and you can’t get the basics?”
— Ali Swenson and Amelia Thomas DeVoe
Swenson reported from New York.
