Losing ground
Edited by Sadie Harley,
reviewed by Robert
Egan
 |
| Share of U.S. adults who are "Cost Secure" dips below half. Credit: West Health-Gallup Center on Healthcare in America |
New research released from the West Health-Gallup Center on Healthcare in America finds that fewer than half of Americans (49%) are considered "Cost Secure," meaning they can consistently afford health care and prescription medications when and where they need them, the lowest level recorded since West Health and Gallup launched its Healthcare Affordability Index in 2021.
In the past year alone, 2.8 million Americans dropped out of
the Cost Secure category, unable to keep up with rising health care costs. The
new data largely extend last year's downward trends, with continued declines in
affordability evident among traditionally vulnerable populations, including
Black and Hispanic adults and lower-income households.
"The fact that fewer than half of Americans can
reliably afford health care should alarm every person, policymaker and health
care leader in the country," said Tim Lash, president of the West Health
Policy Center.
"Millions of Americans are being priced out of health
care because costs are rising faster than their ability to pay. Without
meaningful reforms that better address health care delivery, high prescription
drug prices and rising insurance premiums, Americans will continue to struggle
and affordability will only continue to deteriorate."
Health care spending is on the rise in the U.S., reaching
$5.3 trillion in 2024, a 7.2% increase from the prior year and growing more
than twice the rate of overall inflation (2.9%). Hospital prices climbed 3.4%
in 2024, the fastest increase since 2007, while prescription drug spending rose
7.9%.
The new findings about health care affordability come from the latest West Health-Gallup Healthcare Affordability Index, which measures Americans' ability to access and pay for health care based on self-reported experiences collected through timely, nationally representative surveys. Based on their responses, Americans fell into one of three groups:
- Cost
secure: able to consistently access and afford needed health care
and prescription medications (49% of U.S. adults in 2025)
- Cost
insecure: lacking access to care or recently unable to pay for
either care or medicine (41% of U.S. adults in 2025)
- Cost
desperate: lacking access and recently unable to pay for both
care and prescription drugs (10% of U.S. adults in 2025)
Study highlights
- Growing
racial disparities—Currently, just 38% of Black adults and 32% of
Hispanic adults are classified as Cost Secure, compared with 55% of White
adults. Since 2021, these gaps have consistently widened, with cost
security declining more dramatically among Black (-16 percentage
points) and Hispanic (-19 points) adults than among White adults (-3
points).
- Middle
class getting squeezed—About one in three adults in households earning
$120,000 to $179,999 were not Cost Secure in 2025, nor were one in five
earning $180,000 or more a year.
- Young
adults struggling—Adults ages 18 to 29 saw the sharpest decline in
health care affordability. Less than a third of this group (32%) were Cost
Secure in 2025, a 17-point decline since 2021 and a 7-point drop in the
last year alone.
- Troubling
trends for older adults—Though largely covered by Medicare, cost
security among people 65 and older fell from 73% in 2021 to 61% in 2025,
one of the sharpest declines among age groups.
- Chronic
conditions straining affordability—Little more than a third
of people with COPD (34%) or compromised immune systems (38%) were Cost
Secure in 2025, about equal to the share of people reporting mental health
conditions including anxiety (39%) or depression (37%).
- Gender
gap reaches record high—Women have been less Cost Secure than men
since 2021, and the gap is growing. In 2025, 42% of women were Cost Secure
compared with 57% of men—the largest difference on record. Women were 6
percentage points less likely to be considered Cost Secure in 2025 than
the previous year.
The future appears grim and uncertain for millions of
Americans who are increasingly worried about their ability to pay for health
care in the year ahead. According to the West Health-Gallup Healthcare
Affordability Index, worry rose from 42% of respondents to 51%, and concerns
about paying for prescription drugs jumped to 42% from 30% between 2021 and
2025.
"The new findings point to a sustained shift in how
Americans perceive the affordability of health care," said Joe Daly,
global managing partner at Gallup. "Since 2021, the share of Americans who
say health care is affordable has declined steadily, suggesting this is part of
a longer-term pattern rather than a one-time drop since last year."
Survey methods
Results are based on a Gallup Panel study completed by 5,660
U.S. adults ages 18 and older, conducted Oct. 27–Dec. 22, 2025. The Gallup
Panel is a probability-based panel of U.S. adults recruited via
random-digit-dial phone 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 mail.
The sample was weighted to be demographically representative
of the U.S. adult population using the most recent Current Population Survey
figures. The maximum margin of sampling error is plus or minus 2.1 percentage
points at the 95% confidence level. Margins of error are higher for subsamples.
Prior-year surveys were conducted as follows: 2024 (n=6,296, Nov. 18–Dec. 27,
2024); 2023 (n=5,149, Nov. 13, 2023–Jan. 8, 2024); 2022 (n=5,551, June 21–July
1, 2022); 2021 (n=4,843, Sept. 27–30 and Oct. 18–21, 2021).
Provided by West Health
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Sadie Harley:
BSc Life Sciences & Ecology. Microbiology lab background with
pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
Robert Egan:
Bachelor's in mathematical biology, Master's in creative writing. Well-traveled
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