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For the first time in five years, fewer than half of Americans can consistently afford healthcare, putting additional pressure on an already stressed nonprofit healthcare system.
According to new data from the West Health-Gallup Affordability Index, just 49% of U.S. adults are now classified as “Cost Secure,” meaning they can afford access to quality care and have been able to pay for visits and prescriptions in recent months.
The share of Americans who are Cost Secure has fallen seven percentage points from 2021 (56%), when measurement began, and is in steady decline from its peak of 61% in 2022. Between 2024 and 2025 alone, an estimated 2.8 million Americans dropped out of the Cost Secure category. Notably, these latest findings reflect conditions prior to the expiration of the enhanced ACA subsidies.
West Health and Gallup developed the Healthcare Affordability Index in 2021. Drawing on self-reported experiences from nationally representative surveys, the Index categorizes individuals into one of three groups based on their ability to afford and access needed care using the following criteria:
- Cost Secure individuals say they have access to quality, affordable care and have recently been able to pay for both needed care and medicine (49% of U.S. adults in 2025).
- Cost Insecure individuals say they lack access to quality, affordable care or have recently been unable to pay for either needed care or medicine (41% of U.S. adults in 2025).
- Cost Desperate individuals say they lack access to quality, affordable care and have recently been unable to pay for both needed care and medicine (10% of U.S. adults in 2025).
The latest findings are from an Oct. 27-Dec. 22, 2025, study conducted by the West Health-Gallup Center on Healthcare in America. The study included a nationally representative sample of 5,660 adults aged 18 and older via the Gallup Panel and used both web and mail surveys.
The new data largely extend last year’s downward trends, with continued declines in affordability evident among Black and Hispanic adults. Currently, just 38% of Black adults and 32% of Hispanic adults are classified as Cost Secure, compared with 55% of White adults. Since 2021, these gaps have consistently widened, with cost security declining more dramatically among Black (-16 percentage points) and Hispanic (-19 points) adults than among White adults (-3 points).
