A new study released today by the West Health Gallup Center found that less than half (49%) of Americans consider themselves “cost-secure,” meaning they can consistently afford health care and prescription drugs when and where they need it, the lowest level since West Health and Gallup released their 2021 Healthcare Affordability Index.
Last year alone, 2.8 million Americans dropped out of the Cost Secure category due to their inability to keep up with rising healthcare costs. The new data largely extends last year’s downward trend, with continued declines in affordability evident among traditionally vulnerable populations, such as Black and Hispanic adults and low-income households.
“The fact that less than half of Americans can reliably pay for their health care should be a wake-up call to everyone in the country, policy makers, and health care leaders,” said Tim Rush, director of the West Health Policy Center. “Millions of Americans are struggling to pay for health care as health care costs rise faster than they can pay. Without meaningful reforms to better address health care delivery, high prescription drug prices, and rising insurance premiums, Americans will continue to suffer and affordability will continue to worsen.”
Medical spending in the United States is on the rise, reaching $5.3 trillion in 2024, an increase of 7.2% from the previous year, more than double the overall inflation rate (2.9%). Hospital prices rose 3.4% in 2024, the highest growth rate since 2007, while prescription drug spending increased by about 7.9%.
The new findings on health care affordability come from the latest West Health Gallup Health Care Affordability Index, which measures Americans’ access to health care and their ability to pay for it, based on self-reported experiences collected through timely, nationally representative surveys. Based on their answers, Americans were categorized into one of three groups:
- safe cost – Ability to consistently access and afford necessary medical care and prescription drugs (49% of U.S. adults in 2025)
- worried about cost – Lack of access to care or recent inability to pay for either care or Medicines (41% of US adults in 2025)
- hopeless cost – Lack of access and recent inability to pay for both medical bills and Prescription drugs (10% of US adults in 2025)
Research highlights
- Growing racial disparity – Currently, only 38% of Black adults and 32% of Hispanic adults are classified as cost-safe. 55% of white adults. These disparities have widened consistently since 2021, with cost coverage declining more dramatically for Black (-16 points) and Hispanic (-19 points) adults than for White adults (-3 points).
- oppressed middle class – In 2025, about 1 in 3 adults in households with incomes between $120,000 and $179,999 will not be able to afford their costs, and even less than 1 in 5 in households with annual incomes of $180,000 or more.
- young people struggling – Adults ages 18 to 29 saw the steepest decline in health care affordability. Less than a third (32%) of this group will be able to secure costs in 2025, down 17 points from 2021 and down 7 points in the last year alone.
- A worrying trend for older people – Although largely covered by Medicare, cost coverage for people 65 and older fell from 73% in 2021 to 61% in 2025, one of the steepest declines among age groups.
- Chronic diseases squeeze affordability – a little more One-third (34%) of COPD patients or a weakened immune system (38%), with funding secured in 2025, was similar to the proportion of people reporting mental health conditions such as anxiety (39%) and depression (37%).
- Gender inequality reaches record high – From 2021 onwards, women will have lower cost security than men, and the gap is widening. In 2025, 42% of women will be able to afford it, compared to 57% of men, the largest difference ever. Women are 6 percentage points less likely to be considered cost secure in 2025 than the previous year.
The future looks grim and uncertain for millions of Americans who are increasingly concerned about their ability to pay their health care bills over the coming year. According to the West Health-Gallup Healthcare Affordability Index, between 2021 and 2025, anxiety rose from 42% to 51% of respondents, and concerns about paying for prescription drugs jumped from 30% to 42%.
New survey results show continued changes in how Americans perceive health care affordability. The share of Americans who say their health care is affordable has steadily declined since 2021, suggesting this is part of a long-term pattern rather than a temporary decline from last year. ”
Joe Daly, Gallup Global Managing Partner
Research method
The results are based on a Gallup panel survey of 5,660 U.S. adults ages 18 and older conducted from Oct. 27 to December. The Gallup Panel is a probability-based panel of U.S. adults recruited through random-digit dialing telephone interviews and address-based sampling (ABS) methods. Respondents with internet access completed the survey online. Those without regular internet access were sent a printed questionnaire to complete and return by post. The sample is weighted to be demographically representative of the U.S. adult population using the most recent Current Population Survey numbers. The maximum allowed sampling error is ±2.1 percentage points at the 95% confidence level. The margin of error is higher for subsamples. The previous year’s survey was conducted as follows: 2024 (n=6,296, November 18-December 27, 2024). 2023 (n=5,149, November 13, 2023 to January 8, 2024); 2022 (n=5,551, June 21 to July 1, 2022); 2021 (n=4,843, September 27-30 and October 18-21, 2021).
