A growing healthcare affordability crisis is impacting millions across the United States, with more than one-third of Americans (35%)—an estimated 91 million people—reporting they cannot access quality healthcare when needed, according to the latest West Health-Gallup Healthcare Affordability Index.
The report, which has been tracking healthcare access and affordability in the U.S. since 2021, reveals alarming disparities across racial and economic lines. Black and Hispanic Americans are disproportionately affected, with 46% and 52%, respectively, saying they cannot afford the healthcare they need.
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While higher-income households have maintained relatively stable access to care, the financial burden has surged among lower-income Americans. Nearly two-thirds (64%) of individuals earning under $24,000 annually, and 57% of those earning between $24,000 and $48,000, reported increased difficulty affording healthcare—marking 11- and 12-point increases, respectively, from 2023.
The findings highlight an urgent need for healthcare policy reform, as rising costs continue to widen the gap in healthcare equity and access across the nation.
“The rising trajectory in the inability to pay for healthcare is a disturbing trend that is likely to continue and even accelerate,” said Tim Lash, president of West Health Policy Center, part of a group of nonprofit organizations focused on healthcare and aging. “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. The human and economic costs are enormous.”
The West Health-Gallup Healthcare Affordability Index categorizes Americans into one of three groups:
Cost Secure: faced no recent difficulty accessing or affording care or paying for prescription medicine
Cost Insecure: recently unable to access care or afford either care or prescription medicine
Cost Desperate: recently unable to access care and afford care and prescription medicine
Based on these criteria, just over half of Americans (51%) are considered Cost Secure, the lowest level since 2021. Hispanic adults saw the greatest declines in security over the four-year period, dropping 17 points to 34%, followed by Black adults, who dropped 13 points to 41%. Overall, about 29 million Americans, or 11% of U.S. adults, are classified as Cost Desperate, a record high.
“Healthcare affordability and access continue to erode nationally, and this issue is especially acute among Black, Hispanic, and lower-income adults. White adults and those in higher-income households, in contrast, remain largely insulated from these worsening trends,” said Dan Witters, senior researcher at Gallup. “Among these groups, this is the widest gap in access to care we have recorded thus far, with many Americans experiencing increased hardship year over year.”
