Only 49% of Americans Were 'Cost-Secure' Last Year — Medical Bills Are the Top Culprit

Here's a number that should make you stop scrolling: fewer than half of Americans — just 49% — could reliably afford their healthcare last year. That's not a fringe group or a low-income-only problem. That's the majority of the country struggling with medical bills, prescription costs, or lack of access to quality care.

The data comes from the West Health-Gallup Affordability Index, which surveys thousands of Americans each year and slots them into three buckets: "cost secure," "cost insecure," or "cost desperate." To be considered cost-secure — basically the baseline of being okay — you need to have access to quality care AND be able to actually pay for your doctor visits and meds when you need them.

In 2022, 61% of Americans cleared that bar. By 2025, that number had fallen to 49% — the lowest since Gallup started tracking it in 2021. In other words, the trend is heading in the wrong direction, and fast.

What makes this story hit different is who it's affecting. You might assume this is mostly a problem for people without much money — and yes, lower-income Americans are hit hardest. But about one-third of households pulling in $120,000–$179,000 a year said they either lacked quality coverage or struggled to afford expenses like prescription drugs. Even one in five households earning $180,000 or more said the same. So if you've got a solid income and you're nodding along thinking "this isn't me," think again.

Young adults are in the roughest spot: only about a third of people aged 18–29 are considered cost-secure. Every age group except those aged 50–65 saw a decline from 2023 to 2025.

Race also plays a big role here. While 55% of white adults were cost secure, only 38% of Black adults and 32% of Hispanic adults said the same — and those gaps have been widening since tracking began.

The day-to-day impact is real. About 2 in 10 Americans said there was a point in the past three months when they — or someone in their household — couldn't afford a prescribed medication. About 3 in 10 skipped treatment entirely because of the cost. People are cutting back on utilities, driving less to save on gas, and in some cases borrowing money just to cover healthcare bills.

Here's the kicker: this data was collected between October and December 2025 — before the Affordable Care Act (ACA) tax subsidies expired in early 2026 and caused premiums to spike. That means what we're seeing in this poll may actually understate how bad things are right now. ACA enrollment has already dipped by more than 1 million from 2025, and one health policy nonprofit estimates nearly 5 million fewer people will sign up for ACA plans this year.

The bottom line: if you've ever winced at an Explanation of Benefits, delayed a doctor's visit because of cost, or chosen a lower-tier insurance plan to save money on premiums — you're not alone, and you're squarely in the middle of the story this data is telling.