WASHINGTON — Twannetta Weaver thought she had made a prudent choice when she opted for a high-deductible health plan through her employer, avoiding steep premiums while saving for retirement. But after a slipped disk in her back in 2025, the medical bills piled up so fast that she had to put her college graduation on hold for a year.
“I had to start calculating, am I going to be able to afford to pay my tuition, as well as my books, as well as my living expenses, and continue to care for my family?” said Weaver, 43, of Sanford, Florida. “It makes you feel powerless as a consumer.”
Weaver’s ordeal reflects a broader crisis, according to new data from the West Health-Gallup Affordability Index. The index, released Thursday, found that only about half of U.S. adults had access to high-quality, affordable care and could pay for it last year. That share—49%—marks a steep decline from 56% in 2021, when tracking began, and from a peak of 61% in 2022.
Concerns about affording healthcare in the year ahead hit a record high since the survey started, signaling deepening anxiety as 2025 drew to a close. The findings come from polling conducted from October to December 2025, before recent policy shifts like Medicaid cuts and the expiration of Affordable Care Act subsidies took effect. They underscore how a strained system is squeezing Americans amid persistent inflation and ahead of the midterm elections.
Widespread worry over costs
The index places people into three categories based on their ability to pay for care and medicine and their access to quality treatment. The share of “cost-secure” adults has fallen steadily since 2022. About three-quarters of respondents said healthcare costs were a financial burden, and only 3 in 10 said they were not.
Roughly half of those surveyed were “extremely concerned” or “concerned” that their household would be unable to pay for needed care in 2026, up from 42% in 2022. Inger Perez, 59, of Encino, Texas, said she recently did blood work and is dreading the results given her family’s history of diabetes, high blood pressure, and cancer. “I literally was crying last night because I’m nervous about what I’m going to find out and how much care that is and how much money that is,” she said. “I’m terrified that I’ll start a plan of treatment but won’t be able to afford to keep up with it.”
More than half of respondents said healthcare costs contributed “a lot” or “some” to daily stress, while only about 2 in 10 said they caused no stress at all. Perez also struggles with care quality, living in a rural area an hour from a doctor’s office and relying on a low-cost ACA plan with a limited network.
Affordability drops across demographics
The decline in healthcare affordability and access cut across age and gender lines. Among adults under 30, only about one-third were cost-secure in 2025, down from 46% in 2021. Women fared worse than men, with 42% cost-secure versus 57% for men—a gap that widened last year. Even older Americans on Medicare saw a drop, from 73% in 2021 to 61% in 2025.
The poll also highlighted the trade-offs families make. About 2 in 10 adults said someone in their household couldn’t afford prescribed medicine in the prior three months, and 3 in 10 said they skipped treatment for a health problem due to cost. Xavier Chapa, 55, of Arizona, said his wife’s insurance company reneged on a verbal promise to cover a preventive colonoscopy, leaving them with a $3,000 bill. To cope, the family cut their 8-year-old son’s summer camp from full days to half days. “It’s a lot to deal with,” said Chapa, who returned from Europe three years ago. “What point does it serve if you’re living in this country and having to pay such a high price and you can’t get some of the care?”
The poll’s release comes as Democrats in Congress push an agenda focused on affordability and anti-corruption, while critics like Representative Adam Schiff have blasted a system that created billionaires while millions lack healthcare. Meanwhile, a separate survey found that over a third of Americans doubt the U.S. will survive another 250 years, reflecting broader unease.
