Two-thirds of young adults can't afford the care they need
Across the United States, the ability to afford medical care has reached its lowest recorded point, with fewer than half of Americans now able to reliably pay for doctor visits, prescriptions, and insurance without financial strain. What was once understood as a burden carried primarily by the poor has quietly migrated upward, touching households earning six-figure incomes and reshaping what it means to be financially stable in America. Gallup's tracking data, gathered before a new wave of subsidy changes took effect, suggests the country may be witnessing not a temporary dip but a structural unraveling of healthcare access — one that policy responses have yet to meaningfully reverse.
- The share of Americans who can reliably afford healthcare has fallen from 61% to 49% in just three years, the steepest and lowest reading since measurement began.
- The crisis has broken through class boundaries — one-third of households earning up to $180,000 report they cannot afford coverage or prescriptions, shattering the assumption that financial security insulates against medical cost anxiety.
- Young adults in their twenties are the most exposed, with two-thirds of them making healthcare decisions based on cost rather than medical need.
- A 2026 policy shift cutting ACA premium subsidies is projected to push nearly 5 million people out of insurance plans, accelerating a crisis already at historic lows.
- The Trump administration has launched two initiatives — a premium relief program and a discounted drug platform — but their capacity to reverse the deepening trend remains unproven.
Gallup's latest survey delivers a stark finding: fewer than half of all Americans now possess what researchers call "cost security" — the reliable ability to pay for medical visits, prescriptions, and insurance without financial hardship. In 2022, 61% of Americans met that threshold. Today, that number has fallen to 49%, the lowest point since tracking began in 2021.
What makes this moment particularly significant is where the pain is spreading. Lower-income households have long struggled with medical bills, but the new data shows the squeeze reaching well into the middle and upper-middle class. A third of households earning between $120,000 and $180,000 report they lack adequate coverage or cannot afford their medications. Even among those earning above $180,000, one in five says the same. These are not people on the margins — they are rationing care from positions of relative stability.
The anxiety is nearly universal. More than half of Americans worry about affording medical services in the coming year, and 42% fear they cannot pay for the drugs they need. Young adults aged 18 to 29 are the most vulnerable group, with roughly two-thirds making healthcare choices based on cost rather than clinical need.
The survey was conducted before a significant policy shift made things worse. In early 2026, changes to ACA premium subsidies caused costs to spike, and enrollment is projected to fall by nearly 5 million people this year. The Trump administration has announced two responses — a premium relief program and a discounted prescription drug platform — but whether either will meaningfully slow the erosion remains an open question as more Americans quietly exit the system.
Nearly half of all Americans now lack the financial security to reliably afford medical care. That's the finding from Gallup's latest survey, which tracked a steep decline in what researchers call "cost security" — the ability to pay for doctor visits, prescriptions, and quality insurance coverage without financial strain. In 2022, 61% of Americans could manage these costs. By last year, that figure had collapsed to 49%, the lowest point since Gallup began measuring the metric in 2021.
The erosion is not confined to any single economic tier. While lower-income households have always struggled with medical bills, the new data reveals something more alarming: the squeeze is now reaching solidly middle-class and upper-middle-class families. One-third of households earning between $120,000 and $180,000 annually say they either lack adequate coverage or cannot afford their prescriptions and medical expenses. Even among those making $180,000 or more — a fifth of that group — report the same constraints. These are people with stable jobs and six-figure incomes, and they are rationing healthcare.
Anxiety about medical costs has become nearly universal. Fifty-one percent of Americans polled said they worry about affording medical services in the coming year. Forty-two percent specifically fear they cannot pay for the drugs they need. These numbers span every generation except those aged 50 to 65, who show more stability. Young adults aged 18 to 29 are the most vulnerable: only about one-third of them are cost-secure, meaning two-thirds of people in their twenties are making healthcare decisions based on what they can afford rather than what they need.
The timing of this survey matters. Gallup conducted its interviews between October and December of last year, before a significant policy shift that would likely deepen the crisis. In early 2026, changes to subsidies for health insurance premiums caused costs to spike sharply. The result has been immediate and measurable: enrollment in Affordable Care Act plans is projected to drop by nearly 5 million people this year compared to last year. Some Americans are simply dropping out of the system entirely.
The Trump administration has responded with two initiatives announced in January: a program intended to lower premiums and send money directly to Americans for healthcare costs, and a separate platform offering discounted prescription drugs. Whether these measures will reverse the trend remains unclear. What is certain is that the affordability crisis captured in Gallup's data — already at historic lows — may only worsen as premium increases take full effect and more people discover they cannot sustain their coverage.
Citações Notáveis
Gallup survey shows healthcare affordability concerns span all income levels, with even higher earners reporting inability to afford necessary medical care— Gallup poll findings
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that even people earning $180,000 a year are struggling with medical bills?
Because it tells you the problem isn't just about poverty. It's about the structure of healthcare itself. When six-figure earners can't afford prescriptions, it means the system is broken at a fundamental level, not just at the margins.
The survey was done before the subsidy changes. How much worse could it get?
The enrollment numbers suggest we're already seeing the answer. Nearly 5 million fewer people are expected to sign up for ACA plans this year. That's not a projection anymore — it's happening now.
Young people are hit hardest. What does that mean for the future?
It means a generation is learning to avoid the doctor. They're making healthcare decisions based on price, not health. That compounds over time. Untreated conditions become expensive conditions.
Is there any sign the new administration's programs will help?
It's too early to know. The discounted drug platform and the direct payment program sound promising on paper, but the underlying problem — the cost of care itself — hasn't changed. You can discount a $500 drug to $400, but that's still unaffordable for someone living paycheck to paycheck.
What should people be watching for?
Enrollment numbers in the coming months. If they continue to drop, you'll know people are making a choice to go uninsured rather than pay the premiums. That's the real indicator of how bad this has become.