Fewer than half of Americans can now consistently afford healthcare, according to new research that underscores the growing financial pressure facing households nationwide as medical costs continue to outpace wages and inflation.
New data released by Gallup and West Health found that only 49% of U.S. adults are considered “Cost Secure” in 2025, marking the first time since tracking began in 2021 that a majority of Americans are no longer able to reliably afford healthcare services and prescription medications. At the same time, a separate report from the White House Council of Economic Advisers argues that billions of dollars in savings could be achieved by banning certain contracting practices used by dominant hospital systems.
Together, the reports paint a picture of a healthcare system becoming increasingly unaffordable for patients while policymakers and regulators look for ways to rein in rising costs.
Affordability declines across nearly every demographic
The Gallup findings show healthcare affordability has steadily deteriorated over the past five years. The share of Americans classified as Cost Secure peaked at 61% in 2022 before falling to 49% in 2025. Researchers estimate approximately 2.8 million Americans dropped out of the Cost Secure category between 2024 and 2025 alone.
Another 41% of Americans are now considered Cost Insecure, meaning they struggle with either access to affordable care or paying for healthcare services and medications. Ten percent are classified as Cost Desperate, indicating they face challenges with both access and affordability.
The burden is not falling equally across the population. Just 38% of Black adults and 32% of Hispanic adults are considered Cost Secure, compared with 55% of White adults. Younger adults have experienced some of the sharpest declines, with the share of Americans ages 18 to 29 classified as Cost Secure falling from 46% in 2021 to 32% in 2025.
Even higher-income households are increasingly feeling the strain. Roughly one-third of households earning between $120,000 and $179,999 annually are not considered Cost Secure, while one in five households earning at least $180,000 per year also report affordability challenges.
People managing chronic illnesses and mental health conditions face some of the greatest financial hurdles. Fewer than four in 10 adults with conditions such as depression, anxiety, chronic obstructive pulmonary disease or compromised immune systems are considered Cost Secure.
Americans increasingly worried about future costs
Growing concern about future healthcare costs reflects those trends. More than half of Americans now worry about their ability to pay for healthcare services over the next year, while 42% express concern about affording prescription medications, both record highs in the survey.
Women have also seen affordability worsen at a faster rate than men. Researchers found the gender gap reached its widest point on record in 2025, with women trailing men by 15 percentage points.
Gallup researchers said rising healthcare spending, higher insurance premiums and increasing prescription drug costs appear to be outpacing household income growth. Healthcare spending reached $5.3 trillion nationally in 2024, while healthcare prices continued rising faster than many other sectors of the economy.
The findings suggest affordability challenges are no longer concentrated among low-income households or uninsured Americans. Instead, the financial burden of healthcare is spreading across a broader segment of the population, including many families with employer-sponsored insurance and six-figure incomes.
White House targets hospital contracting practices
The White House Council of Economic Advisers argues part of the solution may lie in increasing competition among healthcare providers.
In a June report, the council examined the impact of banning anti-steering, anti-tiering and all-or-nothing contracts often used by large hospital systems during negotiations with insurers. Federal antitrust lawsuits filed this year against OhioHealth and New York-Presbyterian allege those practices restrict competition and contribute to higher healthcare costs.
Anti-steering provisions prevent insurers from encouraging patients to seek care from lower-cost providers through incentives such as lower copays. Anti-tiering clauses require dominant hospital systems to receive favorable placement within insurance plans regardless of cost. All-or-nothing agreements require insurers to include every hospital and affiliated physician in a system’s network or exclude all of them.
The council contends those arrangements weaken insurers’ negotiating leverage and make it harder for lower-cost providers to compete. Researchers estimate roughly one-quarter of Americans covered by employer-sponsored insurance live in markets where those contract provisions significantly affect competition and pricing.
Billions in potential savings projected
According to the report, eliminating the three practices could reduce hospital and affiliated physician prices by roughly 18% in directly affected markets. Employer-sponsored insurance premiums could decline by about 6.5% in those areas, saving families approximately $1,755 annually and individuals about $606 per year.
Nationally, the report estimates total savings of roughly $45 billion annually, with a projected range between $29 billion and $63 billion depending on market conditions and enforcement outcomes.
The council also argues that lower healthcare costs would benefit workers beyond their insurance premiums. Because employer-sponsored health insurance costs are ultimately borne by employees through lower wages, researchers say reduced healthcare spending could translate into higher take-home pay, increased employment and additional economic growth outside the healthcare sector.
Rural communities could see mixed but generally positive effects, according to the analysis. While hospital systems often argue that higher revenues from large networks help support rural facilities, the council found evidence that independent rural hospitals may gain stronger negotiating positions if the contract restrictions are removed. Rural workers and employers could also benefit from lower insurance costs.
Whether reforms targeting hospital contracting practices can meaningfully slow rising healthcare costs remains to be seen. But with healthcare affordability reaching its lowest level since Gallup began measuring it, policymakers face growing pressure to address a problem that increasingly affects Americans across income levels, age groups and geographic regions.
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