WASHINGTON — Twannetta Weaver believed she made a prudent decision by choosing a high-deductible health insurance plan through her employer, which helped her avoid hefty premiums and save for retirement.
However, in 2025, Weaver suffered a slipped disk in her back, necessitating medication and physical therapy. The resulting medical bills became so overwhelming that she, an adult learner pursuing a leadership degree, had to postpone her graduation by 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?” the 43-year-old from Sanford, Florida, stated in an interview. “It makes you feel powerless as a consumer.”
Weaver’s situation is not unique, as new data from the West Health-Gallup Affordability Index reveals. The report indicates that only about half of U.S. adults could afford their health care and access quality care last year. Concerns about managing health care costs in the future reached a record high since tracking began in 2021, highlighting widespread anxiety as 2025 came to a close.
The findings, released on Thursday, are based on a survey conducted from October to December 2025, prior to significant health policy changes such as Congress’ Medicaid cuts or its decision against extending Affordable Care Act subsidies. This underscores how the nation’s complex health care system is increasingly burdening Americans, especially as inflation drives costs higher and affordability becomes a pivotal issue with midterm elections on the horizon.
Americans are worried they won’t be able to pay for care
The index categorized Americans into three groups based on their access to quality care and ability to afford care and medication. The recent data shows that 49% of U.S. adults were deemed “cost secure,” meaning they could access and afford quality care and necessary medications. In 2021, 56% of adults were “cost secure,” increasing to 61% in 2022 before declining.
According to the survey, about 75% of U.S. adults considered health care costs to be a “major” or “minor” financial burden for themselves and their families, while only about 3 in 10 did not see it as a burden.
Furthermore, around half of the respondents were “extremely concerned” or “concerned” about their household’s ability to pay for necessary health care services in 2026, up from 42% in 2022.
Inger Perez, 59, from Encino, Texas, is among those concerned. With a family history of diabetes, high blood pressure, and cancer, she recently underwent blood work and is anxious about the potential findings and associated costs.
“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 in an interview. “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 the survey participants reported that health care costs significantly contributed to their daily stress, compared to about 3 in 10 who experienced “very little stress” and about 2 in 10 who felt “no stress at all.”
Perez also expressed frustration with the quality of care she receives, partly because she lives in a rural area an hour away from a doctor’s office. To manage her budget, she opted for a lower-cost Affordable Care Act marketplace plan with a limited provider network, presenting another challenge in accessing quality care.
Health care affordability is declining across demographics
In 2025, younger and older adults, as well as women, were among the groups experiencing declines in health care affordability and access, according to the survey.
For Americans under 30, only about one-third were considered “cost secure,” a drop from 46% in 2021. Women were already less likely to be “cost secure” compared to men, and this gap widened last year. The survey results showed that 57% of men were “cost secure” in 2025, down from 67% in 2022, compared to 42% of women.
Older Americans, who are largely covered by Medicare, are generally more likely to be “cost secure.” However, this group also saw a decline, from 73% in 2021 to 61% in 2025.
Patients make sacrifices to pay the bills
Several survey participants shared with The Associated Press the sacrifices they have made to cover their health care expenses.
About 2 in 10 U.S. adults stated that there was a time in the previous three months when they or a household member couldn’t afford prescribed medication due to costs. Additionally, about 3 in 10 reported that they or someone in their household avoided treatment for a health issue because of the expense.
Xavier Chapa, a 55-year-old father from Arizona, disclosed that his 50-year-old wife is in a dispute with her insurance company over a preventive colonoscopy recommended by her doctor.
Despite being verbally assured of coverage, the company refused to honor it after the procedure. Facing a $3,000 bill, they’ve had to reduce their 8-year-old son’s summer camp from full-day to half-day and adjust their budget in other areas.
“It’s a lot to deal with,” said Chapa, who returned to the U.S. 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 basic things?”
— Ali Swenson and Amelia Thomas-Deveaux
Swenson reported from New York.
