Key takeaways:

• Just 49% of Americans could afford health care visits and prescriptions if they needed them.
• Health care systems could help address financial issues through ways like streamlined referrals.

A record number of Americans are unable to consistently afford health care visits and medications if they need them, according to a new West Health and Gallup report.

The findings indicate that “affordability challenges are becoming more widespread,” and “insurance coverage alone does not guarantee affordability,” as many Americans continue to face high deductibles, copayments, coinsurance and prescription drug costs, Zia Agha, MD, chief medical officer at West Health Institute, told Healio.

Data derived from press release.

“Health care affordability is moving in the wrong direction,” Agha said. “Notably, financial barriers are increasing among people with chronic illness, who need ongoing care to remain healthy. When people delay treatment, skip medications or avoid preventive care because of its cost, health outcomes worsen and costs grow even more.”

In the report, survey respondents’ (n = 5,660) financial statuses were measured with the West Health-Gallup Healthcare Affordability Index, which categorized American adults as:

• cost secure, meaning they faced no recent difficulty affording or accessing care or paying for prescription medicine;
• cost insecure, meaning they were recently unable to either access care or afford care or prescription medicine; or
• cost desperate, meaning they were recently unable to access care and afford care and prescription medicine.

More than half of Americans cost insecure, desperate

The researchers found that just 49% of respondents were classified as cost secure in 2025, down from 51% in 2024 — a decrease of an estimated 2.8 million Americans — and the lowest number recorded since West Health and Gallup’s index was launched in 2021, according to a press release.

Meanwhile, 41% and 10% of respondents were classified as cost insecure and cost desperate, respectively.

The report showed that unaffordability was especially prevalent among diverse populations, as 38% of Black adults and 32% of Hispanic adults were classified as being cost secure compared with 55% of white adults.

These disparities have continued to increase since 2021, with cost security dropping more among Black (–16 percentage points) and Hispanic (–19 percentage points) adults vs. white adults (–3 percentage points), the release said.

Americans aged 18 to 29 years had the greatest drop in health care affordability since 2021, the report showed, with those classified as cost secure decreasing from 46% to 32%. This age group “also exhibited one of the largest year-over-year declines between 2024 and 2025, decreasing by seven percentage points,” the release said.

Adults aged 65 years or older remain the likeliest to have financial stability, but even this group has experienced a decrease in those defined as cost secure, dropping from 73% to 61% since the index launched.

West Health and Gallup also reported that women face greater financial insecurity vs. men, with 42% of women being cost secure in 2024 compared with 57% of men.

Additionally, one in three adults in households earning between $120,000 to $179,999 were not cost secure last year.

The decreases in financial stability come as health care spending continues to rise, reaching a record-high $5.3 trillion in the U.S. in 2024 — a 7.2% increase from 2023 — according to the release.

Prescription drug spending also rose by 7.9% and hospital prices by 3.4% in 2024.

Health care systems must address unaffordability

According to Agha, a major problem in health systems is that clinicians are expected to address patients’ financial situations “without having the information or time needed to do so. Most physicians do not have real-time visibility into a patient’s out-of-pocket costs, insurance coverage or medication prices, and a typical 15- to-20-minute visit leaves little opportunity to navigate complex financial issues alongside diagnosis and treatment.”

“Rather than expecting clinicians to become financial counselors, health systems should enable them to identify, refer and coordinate. Clinicians can ask one or two simple screening questions about affordability and document concerns in the electronic health record,” he told Healio. “This should trigger a streamlined referral to financial navigators, social workers, pharmacists or community health workers who have the expertise and time to connect patients with charity care, insurance enrollment, medication assistance programs, transportation or food resources.”

Agha added that health care systems must also provide health care professionals with tools “that make cost-conscious care easier, including real-time prescription cost information, preferred low-cost treatment pathways, and automated referrals embedded within the electronic health record. In this model, the clinician’s role is not to solve every financial problem but to recognize financial hardship as a clinical risk factor and activate the appropriate support team.

“Ultimately, addressing affordability requires a team-based, system-level solution. Just as clinicians rely on specialists for complex medical conditions, they should be able to rely on dedicated financial and social care teams to help patients overcome barriers that affect their ability to receive and adhere to care,” he said. “This approach reduces clinician burden while ensuring patients receive the support they need to achieve better health outcomes.”