The share of Americans who feel financially secure enough to pay for basic healthcare has dropped to its lowest level since 2021, as more patients report skipping prescriptions or making financial trade-offs to cover medical bills.
Drop in affordability
According to the latest West Health–Gallup Healthcare Affordability Index, only 51% of US adults are classified as “Cost Secure”, meaning they have not recently missed care or prescribed medicines due to cost and could afford quality care if needed today. The figure has declined from 61% in 2022, indicating a steady deterioration in perceived affordability.
The remaining 49% of adults fall into the categories of “Cost Insecure” or “Cost Desperate”. The Cost Desperate group, defined as those unable to pay for care, unable to afford prescribed medicines and lacking confidence they could access affordable quality care if needed, has reached 11% of adults for the first time since the survey began.
Affordability pressures vary sharply by income and race. Among households earning under $24,000 a year, 25% of adults are classified as Cost Desperate, compared with 1% of those with incomes of $180,000 or more. Hispanic adults are more than twice as likely as White adults to be Cost Desperate at 18% versus 8%, while the rate among Black adults has reached 14%, the highest level recorded since the survey began.
These pressures are reflected in treatment patterns. A record 18% of adults say they or someone in their household skipped prescribed medicines in the past three months because they could not afford them. Among households earning less than $24,000 annually, the rate rises to 42%.
Financial trade-offs
The West Health–Gallup research partnership has also documented broader financial trade-offs linked to medical bills. In a recent press release, it reported that about one in three US adults, an estimated 82 million people, made at least one “daily life trade-off” in the past year to pay for healthcare expenses, most commonly by rationing prescriptions or borrowing money.
Tim Lash, President, West Health Policy Center, said that when families across income levels must choose between medical bills and other essential expenses such as heating or electricity, “that’s not a personal budgeting problem, it’s a systems failure”.
Healthcare costs are also influencing longer term financial decisions. In a separate West Health and Gallup survey conducted at the end of 2025, many adults reported delaying medical procedures, job changes, home purchases or retirement because of healthcare costs. Joe Daly, Global Managing Partner, Gallup, said the findings highlight “the relationship between healthcare affordability and long-term life planning”.
