The rising cost of living in general – and health care in particular – is forcing many Americans to make tough decisions.
"Millions are expected to face higher insurance premiums and rising out-of-pocket costs as the expiration of some Affordable Care Act subsidies and upcoming cuts to Medicaid enrollment threaten coverage," the latest West Health-Gallup Affordability Index found. "Collectively, these shifts could leave millions of Americans without health insurance at a time when financial stress is already running high."
As a result, roughly one-third of survey respondents -- the equivalent of more than 82 million Americans -- said they have made at least one trade-off with daily living expenses to afford health care. These financial trade-offs are far more common among Americans without health insurance, with 6 in 10 saying they have made at least one sacrifice to pay for health care. This includes one-third who have borrowed money and one-quarter who have prolonged medication. But even among those with insurance, close to 3 in 10 have made at least one sacrifice:
- More than half of adults in households earning less than $24,000 per year report having made at least one trade-off in their daily life to pay for health care.
- The rate is slightly lower (47%) among adults in households earning between $24,000 and less than $48,000.
- One-quarter of adults report making trade-offs in households earning from $90,000 to less than $120,000 annually, as do 11% in households earning $240,000 or more.
Americans who report being in poor or fair health also are more likely to report having made financial trade-offs to pay for their care or medicine compared with those who report better health. This suggests that those who rely most on the health care system may be the most affected.
State rankings released in 2025 showed that residents in states ranking in the bottom 10 based on experiences with health care costs were substantially more likely to report making financial trade-offs to pay for care compared with residents in states ranking in the top 10. However, even in states ranking at the top of the list, such as Massachusetts, Rhode Island and Iowa, about 1 in 10 still report taking these actions.
"As living costs continue to rise, the effects of unaffordable health care are not only confined to medical expenses and decisions," the report concluded. "These findings show that health care costs are shaping how Americans think about the way they live, work and plan for the future.
"While low-income households and those who lack health insurance are most acutely affected, middle-income earners are far from insulated. Even many Americans with six-figure incomes report making financial sacrifices, underscoring that affordability challenges are systemic rather than isolated to any one group."
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