More than one in three Americans cannot afford quality health care when they need it

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April 17, 2025

3 min read

Key takeaways:

A record number of Americans are unable to access affordable care — a trend “that must be turned back,” a researcher told Healio.
Cost insecurity was particularly significant among Black and Hispanic adults.

An estimated record-high 91 million Americans are unable to pay for quality health care if they needed it today, according to a new West Health and Gallup survey.

The inability to pay was especially prevalent among Black and Hispanic adults. Tim Lash, MBA, president of West Health Policy Center, told Healio that the findings “are the consequence of a high-priced health care system.”

Data derived from press release.

“People are skipping or avoiding necessary care in high numbers because they can’t afford it even when many have some form of health insurance. This financial toxicity that travels with health care in this country is, in and of itself, a public health issue,” Lash added. “These are negative trends that must be turned back.”

Using the West Health-Gallup Healthcare Affordability Index, Lash categorized survey recipients as being:

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.

A total of 6,296 people aged 18 years or older responded to the survey.

Number of ‘cost desperate’ adults hits new high

The survey showed that just over half (51%) of Americans were classified as cost secure — the lowest percentage since 2021 — while 11% were classified as cost desperate, a new high.

The greatest reductions among those who were cost secure since 2021 were seen in Hispanic adults, falling 17 percentage points to 34%, and Black adults, who fell 13 percentage points to 41%.

Overall, 35% of adults reported being unable to pay for quality, affordable health care — four percentage points higher than 2023 and a new high since 2021 — while 52% and 46% of Hispanic and Black adults reported being unable to afford such care, respectively.

Upward trends in the cost desperate category since 2021 were also substantial for several subgroups. Specifically:

Hispanic adults rose by eight percentage points to 18%;
Black adults rose by five percentage points to 14%;
households earning under $24,000 annually rose by 11 percentage points to 25%; and
households earning between $24,000 to $48,000 annually rose by six percentage points to 19%.

In contrast, white adults and households earning between $120,000 to $180,000 annually reported no changes in their access to care.

HCPs should consider financial health

According to Lash, the findings mean that “already over-burdened” health care providers “not only need to focus on the physical and mental health of their patients, but they also need to consider their financial health when prescribing medications or other treatments and scheduling future appointments.”

“The ability to afford treatment must be part of the conversation,” he told Healio. “The best medicines are of no use to people who cannot afford them.”

Lash also highlighted several other solutions needed to address these growing gaps in affordability and improve health outcomes, such as “policy reform, including moving from fee-for-service to value-based payment models, limits on out-of-pocket expenses and health insurance premiums and the expansion of Medicare negotiation.”

Ultimately, “the rise is yet another reflection of the financial strain and real-life anxiety facing Americans trying to stay healthy,” he concluded.