The inability to pay for healthcare has reached unprecedented levels in the United States, with more than one-third of Americans—an estimated 91 million people—reporting they cannot afford to access quality healthcare when needed, according to the latest West Health-Gallup Healthcare Affordability Index.
This 35% figure represents a 4-point increase from 2023 and marks the highest level recorded since the index began tracking healthcare affordability in 2021. The findings reveal a healthcare system increasingly out of reach for millions of Americans, particularly those from minority communities and lower-income households.
Widening Disparities in Healthcare Access
The affordability crisis is not affecting all Americans equally. Hispanic Americans (52%) and Black Americans (46%) report significantly higher rates of healthcare inaccessibility compared to the national average. These racial disparities have worsened since 2021, with Hispanic Americans experiencing a 17-point decrease in healthcare security and Black Americans seeing a 13-point drop.
Income disparities are equally stark. Among households earning less than $24,000 annually, 64% report being unable to afford healthcare—an 11-point increase from 2023. Similarly, 57% of households with annual incomes between $24,000 and $48,000 struggle with healthcare affordability, reflecting a 12-point jump from the previous year.
"Healthcare affordability and access continue to erode nationally, and this issue is especially acute among Black, Hispanic, and lower-income adults," said Dan Witters, senior researcher at Gallup. "White adults and those in higher-income households, in contrast, remain largely insulated from these worsening trends. Among these groups, this is the widest gap in access to care we have recorded thus far."
The Growing "Cost Desperate" Population
The index classifies approximately 11% of Americans—about 29 million people—as "Cost Desperate," meaning they are unable to afford either healthcare or prescriptions. This represents a concerning increase across all age groups, with the most significant rise among Americans under 50 years old, where the rate has increased by 4 percentage points to 14%.
Tim Lash, president of West Health Policy Center, described the trend as "disturbing" and likely to accelerate without intervention. "Policy action at both the state and federal level is urgently needed, or even more Americans will have to go without treatment or be forced to make painful tradeoffs between paying for medical care or paying for other necessities," Lash warned. "The human and economic costs are enormous."
Healthcare Security at Record Low
Only 51% of Americans are now considered "Cost Secure," meaning they face no recent difficulty affording either healthcare or prescriptions. This represents the lowest level observed since tracking began in 2021.
The decline in healthcare security has been particularly pronounced among Hispanic Americans, with only 34% reporting no problems affording healthcare—down 17 points from 2021. Black Americans have experienced a similar trend, with those reporting healthcare security dropping 13 points to 41%.
Economic Implications and Consumer Behavior
The affordability crisis is forcing Americans to make difficult financial decisions. Many report cutting spending on utilities and experiencing increased stress due to healthcare costs. There is also growing concern about potential medical debt from unexpected healthcare expenses.
According to KFF data referenced in the study, healthcare costs have consistently outpaced general inflation, with medical care costs increasing by 3.3% from June 2023 to June 2024, compared to an overall consumer price growth of 3.0% during the same period. The United States continues to spend more per capita on healthcare than other wealthy nations, yet access remains problematic for a significant portion of the population.
Methodology and Data Collection
The West Health-Gallup Healthcare Affordability Index survey was conducted online and by mail between November 18 and December 27, 2024. It included 6,296 respondents aged 18 and older from all 50 states and the District of Columbia. The margin of error for the full sample is plus or minus 1.6 percentage points.
Calls for Systemic Reform
Healthcare experts emphasize that the findings highlight the need for comprehensive policy reforms to address the growing affordability crisis. Without intervention, the disparities in healthcare access are likely to widen further, potentially exacerbating health outcomes for vulnerable populations.
As healthcare costs continue to rise faster than wages for many Americans, policymakers face mounting pressure to implement solutions that can make quality healthcare more accessible and affordable for all citizens, regardless of income level, race, or ethnicity.
