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Nearly half of working-age Americans struggled to afford health care in 2025, and more than one-third said someone in their family had unmet health care needs because of high costs.
"Affordability of health care is everyone's concern, not just people who are uninsured," said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation. "In addition to rising premiums, higher out-of-pocket costs make many people less secure and potentially less healthy as they avoid needed care."
The foundation recently funded Urban Institute research on the affordability of U.S. health care. Although 60% of uninsured adults reported affordability challenges, many individuals with health insurance coverage also said their families were challenged by high health care costs.
Among people who get insurance through an employer, 4 in 10 cited affordability challenges, while 54% of those who purchase insurance on their own and 57% of people enrolled in Medicaid reported difficulty affording care. These findings show that health care affordability challenges are not limited to the uninsured but also are common among those with insurance, researchers said.
The challenge of health care affordability was particularly pronounced for working-age adults with disabilities (69%); individuals in fair or poor health (65%); and people with chronic conditions. More than 6 in 10 individuals who had ever been diagnosed with a stroke, chronic obstructive pulmonary disease, cancer, heart disease or diabetes reported affordability challenges. More than half of Black and Hispanic adults; residents of southern states; and people in rural areas reported difficulty affording health care for themselves and their families last year.
Unmet health care needs were the most prevalent challenge faced by individuals and family members, regardless of insurance status. Other financial challenges included amassing medical debt and problems paying medical bills. Slightly less than 3 in 10 respondents reported their family had taken on debt to pay for medical care.
Researchers expect health care to become less affordable for working families in the coming years as new federally mandated Medicaid and Marketplace policies are projected to add millions to the ranks of the uninsured. Some working families that are not eligible for Medicaid already has experienced steep premium increases or higher deductibles for ACA Marketplace plans following the expiration of enhanced premium tax credits last year.
"These findings highlight widespread difficulty in affording health care across the United States," said Michael Karpman, principal research associate at the Urban Institute. "Recent federal policy changes could exacerbate these difficulties by increasing the number of people who are uninsured. And if more employers shift the rising costs of health care to their employees, affordability challenges will increase."
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