Nearly half of U.S. adults, about 44%, say it is difficult to afford their health care costs. That translates to roughly 115 million people struggling to pay for doctor visits, procedures, or medications. The problem extends well beyond the uninsured: millions of Americans who have coverage still can’t afford to use it, and the financial pressure shapes everyday decisions about whether to fill a prescription, see a specialist, or go to the emergency room.
The Scale of the Problem
KFF polling from 2025 found that 44% of adults describe their health care costs as very or somewhat difficult to afford. About 28% say they or a family member had problems paying for care in the past year. And more than a third, 36%, report skipping or postponing care they needed because of cost.
Medication is a particular pain point. Roughly 43% of U.S. adults say they haven’t taken their medication as prescribed in the past year because of cost, whether that means skipping doses, cutting pills in half, or never filling a prescription at all. CDC data from 2021 put the figure for working-age adults at about 8%, but that used a narrower definition and only counted people already taking prescriptions. The broader KFF figure captures the full range of cost-driven medication decisions, including people who never started a prescribed drug.
Medical Debt by the Numbers
Americans collectively owe at least $220 billion in medical debt. About 14 million adults owe more than $1,000, and roughly 3 million owe more than $10,000. These figures come from the Survey of Income and Program Participation, which asks every adult in a household whether they carry medical bills. The true total is likely higher, since many people put medical expenses on credit cards or take out personal loans, moving the debt off the “medical” ledger without eliminating it.
Medical debt behaves differently from other kinds of debt. It’s rarely planned, often arrives after an emergency, and can spiral quickly when a single hospital stay generates separate bills from the facility, the surgeon, the anesthesiologist, and the lab. For people without savings to absorb a surprise bill, one health event can create a financial hole that takes years to climb out of.
Who Struggles Most
Cost barriers hit some communities far harder than others. Among adults under 65, the percentage who went without needed care due to cost in 2024 varied sharply by race and ethnicity:
- Hispanic adults: 23%
- Native Hawaiian or Pacific Islander adults: 19%
- American Indian or Alaska Native adults: 18%
- Black adults: 16%
- White adults: 12%
- Asian adults: 8%
These gaps reflect differences in insurance coverage, income, and the kinds of jobs people hold. Workers in low-wage service and agricultural jobs are less likely to get employer-sponsored insurance, and even when they do, high deductibles can make the plan functionally unusable. Hispanic adults face the highest rate of cost-related skipped care in part because they have the highest uninsured rate of any racial or ethnic group in the country.
What “Affordable” Actually Means
The federal government defines an employer health plan as “affordable” if the worker’s share of the cheapest available premium costs less than 9.02% of household income in 2025 (rising to 9.96% in 2026). That threshold only applies to premiums, not to deductibles, copays, or coinsurance. So a family can have technically “affordable” insurance and still face thousands of dollars in out-of-pocket costs before coverage kicks in.
This is why having insurance and being able to afford care are two different things. A plan with a $3,000 or $5,000 deductible means you’re paying full price for most routine care until you hit that threshold. For a household earning $50,000 a year, that deductible alone represents 6 to 10% of gross income, on top of monthly premiums.
How People Cope
When care feels unaffordable, people make tradeoffs. The most common strategies are also the most dangerous from a health standpoint. Skipping preventive screenings means conditions like diabetes, high blood pressure, or cancer go undetected until they’re more advanced and more expensive to treat. Rationing medication, particularly for chronic conditions, can lead to hospitalizations that dwarf the cost of the original prescription.
Some people split pills, use expired medication, or share prescriptions with family members. Others avoid the emergency room for symptoms they know are serious because they’re worried about the bill. These aren’t rare behaviors. When more than a third of adults say they’ve delayed needed care because of cost, it means tens of millions of people are making these calculations every year.
Health Spending Is Growing Faster Than the Economy
The financial squeeze is projected to get worse. National health spending is expected to grow at an average rate of 5.8% per year through 2033, outpacing GDP growth of 4.3% over the same period. By 2033, health care is projected to consume 20.3% of the entire U.S. economy, up from 17.6% in 2023.
A more immediate concern: the enhanced insurance subsidies created by the Inflation Reduction Act are set to expire, and enrollment in individually purchased health plans is expected to drop by 4.7 million people in 2026 as a result. That’s a 12.3% decline in one year. Many of those people won’t become uninsured, but they’ll likely shift to cheaper plans with higher deductibles, or to no coverage at all, pushing the affordability problem further in the wrong direction.