U.S. Healthcare Affordability Hits Five-Year Low: Fewer Than Half of Adults Now 'Cost Secure'
核心洞察
For the first time since 2021, fewer than half of U.S. adults (49%) are classified as "Cost Secure," meaning they can consistently afford quality healthcare and prescriptions.
The share of Cost Secure Americans has fallen seven percentage points from 56% in 2021, with an estimated 2.8 million adults dropping out of this category between 2024 and 2025 alone.
Sharp declines were observed among Black adults (38% Cost Secure), Hispanic adults (32%), young adults aged 18-29 (32%), and those with chronic conditions such as COPD (搜索) (34%) and depression (搜索) (37%).
Fewer than half of U.S. adults can now consistently afford their healthcare, marking the first time the share has dipped below 50% since measurement began in 2021. According to the latest West Health (搜索)-Gallup (搜索) Affordability Index, just 49% of Americans are classified as "Cost Secure" — meaning they have access to quality, affordable care and have recently been able to pay for both needed medical visits and prescription medications.
The findings, drawn from a nationally representative survey of 5,660 adults conducted between October 27 and December 22, 2025, reveal a steady erosion of healthcare affordability. The proportion of Cost Secure Americans has fallen seven percentage points from 56% in 2021 and is down sharply from its peak of 61% in 2022. Between 2024 and 2025 alone, an estimated 2.8 million Americans dropped out of the Cost Secure category. Notably, these data reflect conditions prior to the expiration of enhanced Affordable Care Act subsidies.
The West Health (搜索)-Gallup (搜索) Healthcare Affordability Index categorizes individuals into three groups: Cost Secure (49% in 2025), Cost Insecure — those who lack access to quality, affordable care or have recently been unable to pay for needed care or medicine (41%), and Cost Desperate — those who lack access and have been unable to pay for both care and medicine (10%).
Widening Disparities Across Race, Age, and Gender
The decline in affordability has not been evenly distributed. Black and Hispanic adults have experienced disproportionately steep drops. Currently, just 38% of Black adults and 32% of Hispanic adults are classified as Cost Secure, compared with 55% of White adults. Since 2021, cost security has declined by 16 percentage points among Black adults and 19 points among Hispanic adults, versus a 3-point decline among White adults.
Young adults aged 18 to 29 have experienced the sharpest decline of any age group, with the share classified as Cost Secure falling from 46% in 2021 to just 32% in 2025 — a 14-point drop. This group also showed one of the largest year-over-year declines, decreasing by seven percentage points between 2024 and 2025.
Adults aged 65 and older, who are typically covered by Medicare, remain the most likely to be Cost Secure, but this group has also seen meaningful erosion. The share of Cost Secure older adults fell from 73% in 2021 to 61% in 2025, with a substantial year-over-year decline from 69% in 2024.
The gender gap in healthcare affordability reached its widest point since measurement began. In 2025, 57% of men were Cost Secure compared to just 42% of women — a 15-percentage-point gap, up from an average of nine points between 2021 and 2024. The share of Cost Secure women fell from 48% in 2024 to 42% in 2025, the steepest single-year drop recorded.
Chronic and Mental Health Conditions Amplify Burden
Americans with chronic conditions face substantially greater affordability challenges. Only 34% of adults with COPD (搜索) are Cost Secure, as are just 38% of adults with compromised immune systems. People with mental health conditions are similarly affected: just 39% of those with anxiety (搜索) and 37% of those with depression (搜索) are Cost Secure, meaning more than six in 10 struggle to pay for healthcare services and prescriptions. Even after accounting for age, gender, race/ethnicity, and income, individuals reporting chronic conditions are more likely to report struggling to afford healthcare than those without these conditions.
Income Does Not Guarantee Security
Although Cost Secure status correlates with higher household income, substantial shares of middle- and upper-middle-income households are not protected. About one-third of households earning between $120,000 and $179,999 annually are not Cost Secure, nor are one in five respondents in households earning $180,000 or more.
Record Concern About Future Affordability
Concern about affording healthcare in the year ahead has reached the highest level recorded since tracking began in 2021. Worry about paying for prescription drugs has climbed steadily from 30% in 2021 to 42% in 2025. Concern about paying for needed healthcare services rose from 42% to 51% over the same period. About three-quarters of U.S. adults said healthcare costs were a "major" or "minor" financial burden for their family, and more than half said the cost of healthcare contributes "a lot" or "some" stress to their daily lives.
In the 2025 survey, approximately two in 10 adults reported that they or a household member had been unable to pay for prescribed medicine in the prior three months due to costs, and about three in 10 said they or someone in their household did not seek treatment for a health problem because of the expense.
Systemic Cost Pressures
The report notes that healthcare spending reached $5.3 trillion — or $15,474 per person — in 2024, representing 7.2% growth from the previous year, while inflation rose by less than half that amount (2.9%). Hospital prices climbed 3.4% in 2024, the fastest rate of increase since 2007, and prescription drug spending rose approximately 7.9%. Insurance premiums have increased about 20% following the expiration of enhanced ACA subsidies.
"If left unaddressed, these trends risk contributing to delayed care, poorer health outcomes, increased medical debt, greater health system burden and, by extension, even more cost," the West Health (搜索)-Gallup (搜索) analysis concludes.