🟠 Moderate Evidence
Fewer than half of Americans—49%—can reliably afford healthcare and prescription medications when needed, according to the West Health-Gallup Center on Healthcare in America. This represents the lowest affordability level since the Healthcare Affordability Index launched in 2021, signalling a deepening crisis in medical access across the United States.
Key takeaways
- 49% of Americans are “Cost Secure”—able to consistently afford healthcare and medications—the lowest since 2021
- The majority of the US population now faces financial barriers to essential medical care
- Findings suggest urgent policy and healthcare system reforms needed to restore affordability
Study at a Glance
| Source | West Health-Gallup Center on Healthcare in America |
| Study type | Population survey / Healthcare Affordability Index |
| Population | US adults |
| Metric | “Cost Secure” status (ability to afford healthcare and medications) |
| Time period | 2021–2026 |
US Healthcare Cost Security Declining Since 2021
Percentage of Americans “Cost Secure” (able to afford healthcare and medications consistently), West Health-Gallup Center, 2021–2026
Source: West Health-Gallup Center on Healthcare in America, 2026 | Georgian Medical Journal News
Widening gap in medical affordability
The West Health-Gallup Center’s findings reveal that a majority of the American population now faces financial barriers when accessing necessary medical care. Being “Cost Secure,” as defined by the survey, means individuals can consistently pay for healthcare visits and prescription medications without financial hardship—a threshold that fewer than half of US adults now meet.
The steady decline from 53% in 2021 to 49% in 2026 suggests systemic pressures on healthcare affordability are intensifying. This metric serves as a key indicator of population health system performance and has direct implications for medication adherence, preventive care utilization, and chronic disease management across the nation.
Economic drivers and vulnerable populations
While the West Health-Gallup Center survey does not provide detailed breakdowns by demographic group in the source summary, research from the Kaiser Family Foundation has consistently shown that healthcare affordability crises disproportionately affect low-income households, racial and ethnic minorities, and individuals with chronic conditions. The timing of the West Health-Gallup findings—during a period of inflation and rising prescription drug costs—suggests multiple economic factors may be contributing to the deterioration.
Cost-related barriers to care include delayed or skipped medical visits, non-adherence to prescribed medications, and rationing of essential treatments. These gaps in access are known to worsen health outcomes and increase downstream emergency care utilization, creating a cycle that ultimately costs the healthcare system more.
Policy and systemic implications
The Healthcare Affordability Index represents an attempt to move beyond traditional insurance coverage metrics and measure actual out-of-pocket financial burden on patients. The index’s decline to a 5-year low underscores that health policy and reform strategies focused solely on insurance enrollment rates may miss the broader affordability crisis facing insured and uninsured populations alike.
Policy responses being discussed include price transparency initiatives, drug pricing reform, and expanded subsidies for prescription medications and out-of-pocket costs. The Centers for Medicare & Medicaid Services (CMS) and Congress have begun exploring measures to cap patient cost-sharing and negotiate drug prices, though implementation timelines remain uncertain.
Fewer than half of Americans (49%) are now “Cost Secure,” meaning they can consistently afford healthcare and prescription medications when needed—the lowest level recorded since the Healthcare Affordability Index launched in 2021.
— West Health-Gallup Center on Healthcare in America (2026)
What this means
Frequently asked questions
What does “Cost Secure” mean?
According to the West Health-Gallup Center, “Cost Secure” refers to individuals who can consistently afford healthcare services and prescription medications when and where they need them, without experiencing financial hardship. The inverse—cost insecurity—means individuals face barriers, delays, or choices between purchasing medications and other necessities.
Why is affordability declining despite insurance coverage expansion?
Insurance coverage and actual affordability are distinct measures. Even insured individuals face rising deductibles, copayments, and coinsurance, as well as out-of-network costs. Rising prescription drug prices and medical service inflation have outpaced insurance benefit improvements, leaving many patients with unmanageable out-of-pocket expenses.
What policy changes could improve affordability?
Proposed reforms include federal price negotiation for prescription drugs (as authorized by recent legislation), caps on annual out-of-pocket maximums, expanded insurance subsidies, and transparency requirements for healthcare pricing. Clinical and policy communities continue to debate the most effective combination of interventions.
As healthcare costs continue to rise faster than wage growth and inflation, the affordability crisis threatens to deepen unless policymakers implement sustained, evidence-based reforms. The West Health-Gallup Center’s index provides critical data for tracking progress—or continued deterioration—in population access to essential care. Continued monitoring of this metric, paired with granular analysis of which populations face the steepest barriers, will be essential for targeting interventions effectively.
Source: Americans’ ability to afford health care falls to 5-year low — West Health-Gallup Center on Healthcare in America (2026)
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