Survey Reveals What Americans Sacrifice Due to High Healthcare Costs

The numbers are staggering, and they are getting worse. Approximately one in three American adults — an estimated 82 million people — reported making at least one trade-off in their daily living expenses over the past year to afford healthcare, according to a sweeping West Health-Gallup survey released in March 2026 [1]. The findings paint a picture of a country where even middle-class families with employer-sponsored insurance are being forced to choose between medical bills and life's basic necessities.

The data arrives at a moment of deepening crisis. Enhanced Affordable Care Act premium subsidies lapsed at the end of 2025, marketplace premiums have more than doubled for millions of enrollees, and the Consumer Price Index for medical care continues its relentless climb [2][3]. What was once a problem confined largely to the uninsured has metastasized into a systemic burden touching every income bracket and every corner of the country.

The Sacrifices: From Prescription Rationing to Postponed Dreams

The West Health-Gallup poll, based on interviews with thousands of U.S. adults, catalogued the specific ways Americans are trimming their lives to accommodate healthcare costs. The most common sacrifices were prescription rationing — stretching out doses or skipping medication entirely — and borrowing money, each reported by 15% of respondents [1].

But the toll extends far beyond pills and payday loans. The survey estimates that as many as 46 million Americans delayed changing jobs because they feared losing healthcare coverage. Roughly 37 million put off buying a home. Forty million scrapped plans to pursue additional education or job training. And nearly 24 million — about one in ten adults — postponed retirement [1][4].

These are not marginal life adjustments. They represent a reshaping of the American economic landscape, where healthcare costs function as an invisible anchor on labor mobility, homeownership, and human capital development.

"The cost of healthcare is now dictating major life decisions for tens of millions of Americans," the Gallup report noted, calling the findings "a healthcare affordability emergency" [1].

Who Bears the Heaviest Burden

The financial strain cuts across demographics, but it falls disproportionately on the most vulnerable. Among households earning less than $24,000 per year, 55% reported making at least one daily-living sacrifice. For uninsured Americans, that figure climbed to 62%, with nearly a third borrowing money and a quarter prolonging medication doses [1].

Yet the crisis is no longer confined to poverty. A quarter of adults in households earning $90,000 to $120,000 per year — roughly 9 million people — said they too were making trade-offs. Even among those earning $240,000 or more, 11%, or about 1.6 million adults, reported healthcare-driven financial sacrifices [1].

Racial and ethnic disparities are stark. According to the Kaiser Family Foundation's tracking poll, 55% of Hispanic adults and 49% of Black adults report difficulty affording healthcare costs, compared with 39% of White adults. Hispanic adults (41%) and young adults ages 18 to 29 (40%) were the most likely to report problems paying for care in the past year [5].

Source: West Health-Gallup 2026 Survey

Data as of Mar 12, 2026CSV

Skipping Care — and Paying the Price

The consequences of healthcare cost avoidance are not merely financial. They are clinical. KFF's November 2025 Health Tracking Poll found that 36% of adults skipped or postponed needed healthcare in the past 12 months due to cost — a figure that has risen sharply in recent years [5]. A separate Imagine360 survey of 2,500 adults found 38% of insured Americans delayed or skipped care, a 41% increase over the 27% reported in its 2023 study [6].

Among those who deferred care, 18% reported that their health deteriorated as a result. For uninsured adults under 65, that figure reached 42% [5]. Most alarmingly, 9% of adults said they knew someone who died after not receiving treatment they could not afford — up from 5% in 2022 [5].

Prescription drug costs are a particularly acute pressure point. The share of Americans reporting that they or a household member could not pay for medications in the past three months reached a record 20% in the latest West Health-Gallup tracking, up steadily from lower levels when tracking began in 2021 [2]. One in five Americans who filled a prescription in 2025 reported rationing their medication due to cost [7].

The KFF data shows the breadth of medication cost-coping: 21% of adults had not filled a prescription due to cost, 23% substituted over-the-counter drugs, and 15% cut pills in half or skipped doses [5].

The Medical Debt Spiral

For millions, the sacrifices are not enough to prevent a deeper financial crisis. The Consumer Financial Protection Bureau has estimated that 100 million Americans carry a collective $220 billion in medical debt — more than any other category of consumer debt in collections [8].

KFF's research found that 41% of adults currently have some form of medical or dental debt, and 24% have past-due medical bills they cannot pay. Half of Americans said they could not pay an unexpected $500 medical bill outright [5]. The consequences cascade: about 1 in 12 Americans with healthcare debt have lost their home to eviction or foreclosure at least partly because of what they owed, and about 1 in 5 have had to move in with family or friends [8].

Medical bills are implicated in as many as 66.5% of personal bankruptcies, with an estimated 550,000 people filing each year primarily due to medical costs [8]. Two-thirds of adults with healthcare debt related to cancer cut spending on food, clothing, or other basics [8].

A System That Costs More and Delivers Less

The United States spends far more on healthcare than any other wealthy nation — $14,885 per capita according to the latest OECD data, compared with an OECD average of $5,967 [9]. That figure is more than $3,700 higher than the next most expensive country. As a share of GDP, U.S. healthcare spending stands at 17.2%, nearly double the OECD average of 9.3% [9].

Source: World Bank / WHO Global Health Expenditure Database

Data as of Feb 24, 2026CSV

Yet this extraordinary spending does not translate into superior access or outcomes. The Peterson-KFF Health System Tracker has documented that utilization rates for many services in the United States are actually lower than in other wealthy OECD countries, suggesting that prices — not overuse — are the primary driver of the cost gap [9].

The medical care component of the Consumer Price Index has climbed steadily, rising from approximately 551 in January 2023 to nearly 593 in February 2026, reflecting a roughly 7.5% increase over three years [3]. While this tracks below the broader inflation surge of 2021-2022, medical costs have shown no signs of decelerating, even as overall inflation has moderated.

Source: Bureau of Labor Statistics / FRED

Data as of Mar 12, 2026CSV

Record Anxiety Heading Into 2026

Americans' worry about future healthcare costs has reached its highest point since tracking began. The West Health-Gallup survey found that 47% of adults — nearly half the country — are worried they will not be able to afford healthcare next year, the highest level recorded since the series launched in 2021 [2][4].

The share of adults who say healthcare costs cause "a lot of stress" in their daily lives has nearly doubled since 2022, rising from 8% to 15%. Concerns about prescription drug costs have climbed from 30% in 2021 to 37% in 2025 [2].

This anxiety is well-founded. The expiration of enhanced ACA premium tax credits at the end of 2025 has already begun reshaping the insurance landscape. The Urban Institute projected that 4.8 million people would lose coverage in 2026 [10]. Average premiums for subsidized marketplace enrollees have more than doubled — a 114% increase from an average of $888 in 2025 to $1,904 in 2026, according to KFF [11]. For those with incomes below 250% of the federal poverty level, average net premiums jumped from $169 to $919 [11].

ACA marketplace enrollment for 2026 declined to 22.8 million, down from 24.3 million the prior year, as affordability barriers pushed people off the rolls [12]. Rural areas and communities of color, which already face significant barriers to accessing care, are expected to be disproportionately affected, with uninsured rates projected to increase by as much as 65% in Mississippi and 50% in South Carolina [10][12].

The Employer Insurance Squeeze

Even Americans with employer-sponsored coverage — long considered the backbone of the U.S. health insurance system — are feeling the pressure. The 2025 KFF Employer Health Benefits Survey found that premiums for job-based family coverage rose 6% to an average of $26,993 per year [13]. As one KFF Health News headline put it: that is roughly the cost of a new car [13].

Average annual deductibles for employer-sponsored plans reached $1,886 in 2025, with nearly half of plans (46%) carrying an out-of-pocket maximum above $5,000 [14]. PWC's medical cost trend analysis projects employer health plan costs will continue rising at 7-8% annually through 2026, well above general inflation [14].

The result is a growing class of Americans who are technically insured but functionally underinsured — carrying insurance cards that offer diminishing protection against the actual cost of getting sick.

A Crisis Without a Clear Exit

The healthcare affordability crisis sits at the intersection of policy failure, market dynamics, and structural inequality. Federal spending cuts and the lapse of ACA subsidies have removed a critical buffer for lower- and middle-income families [10][12]. Drug prices continue to rise despite legislative efforts like the Inflation Reduction Act's Medicare negotiation provisions. And the consolidation of hospital systems and insurer markets has limited competitive pressure on prices [14].

Polling consistently shows that healthcare cost is among Americans' top concerns. The Gallup and West Health data found that cost leads all other top-of-mind healthcare issues, outpacing quality of care, access, and insurance coverage as the dominant worry [4].

For the 82 million Americans already making daily sacrifices — and the millions more teetering on the edge — the question is not whether the system is broken. It is how long the country can sustain a healthcare economy that forces its citizens to choose between their health and their financial survival.