‘I literally was crying last night because I’m nervous about what I’m going to find out’: a record 51% of Americans aren’t ‘cost secure’ on health

Twannetta Weaver felt like she made the responsible choice when she enrolled in a high-deductible health insurance plan through her employer, an option that avoided high premiums and allowed her to save for retirement. Then, in 2025, she slipped a disk in her back, requiring medication and physical therapy. Suddenly, the medical bills were so overwhelming that Weaver, an adult learner working toward a leadership degree on the side, had to delay graduation by a year. “I had to start calculating, am I going to be able to afford to pay my tuition, as well as my books, as well as my living expenses, and continue to care for my family?” the 43-year-old in Sanford, Florida, said in an interview. “It makes you feel powerless as a consumer.” Weaver’s experience is familiar to a growing number of Americans, according to new data from the West Health-Gallup Affordability Index, which shows only about half of U.S. adults could afford their healthcare and had access to quality care last year. Concerns about affording healthcare in the year ahead were at a record high since tracking began in 2021, signaling that many were feeling anxious about rising healthcare costs as 2025 ended. The new findings published Thursday draw on a survey conducted from October to December 2025 — before major recent changes to health policy, like Congress’ Medicaid cuts or its decision not to extend Affordable Care Act subsidies, took effect. It demonstrates how the country’s fraught healthcare system is increasingly straining Americans at a time when inflation is driving high costs and affordability concerns are top of mind as midterm elections approach. Americans are worried they won’t be able to pay for care The index used the responses from multiple questions to place Americans into three categories depending on their access to quality care and ability to pay for care and medicine. In the new data, 49% of U.S. adults were considered “cost secure,” meaning that they had access both to high-q