One in Three Americans Face Hard Trade-offs to Afford Rising Healthcare Costs

The financial architecture of American life is increasingly being defined by a single, inescapable burden: the cost of staying healthy. According to a comprehensive new study from the West Health-Gallup Center on Healthcare in America, the crisis of healthcare affordability has reached a tipping point where one-third of all U.S. adults—equivalent to approximately 82 million people—are making significant sacrifices in their daily lives to cover medical expenses. This is no longer a fringe issue affecting only the uninsured or the most vulnerable; it is a systemic failure that is reshaping the middle class and altering the life trajectories of millions.

The findings, based on surveys conducted in 2025 and released in March 2026, paint a stark picture of a nation where medical care is frequently traded for food, heat, and basic mobility. As the West Health-Gallup Affordability Index indicates, the situation has deteriorated significantly over the last few years, driven by a combination of high insurance premiums, rising out-of-pocket costs, and the expiration of pandemic-era subsidies that previously provided a temporary buffer for many families.

The Daily Cost of Survival

For millions of Americans, the choice between medicine and basic survival is not a metaphor; it is a monthly calculation. The Gallup data reveals that the most common trade-offs involve immediate, high-stakes decisions. Roughly 15% of Americans—about 39 million people—report prolonging their current prescriptions, which often means “rationing” medication by skipping doses or cutting pills in half. Another 15% have been forced to borrow money to cover medical bills, a practice that fuels a vicious cycle of high-interest debt that can last for years.

The sacrifices extend into the most fundamental aspects of human necessity. Approximately 11% of U.S. adults reported skipping meals to pay for healthcare, while an equal percentage said they drove less to save on gas money specifically to afford treatment. Perhaps most alarming is that 9% of the population—roughly 23 million people—had to cut back on essential utilities like heating or electricity to ensure they could see a doctor or pay for a prescription.

These statistics represent a profound failure of the American social contract. When nearly 30 million people are skipping meals to pay for the very care meant to keep them alive, the healthcare system is effectively undermining the public health it is designed to protect. Malnutrition and the lack of proper home heating are themselves major drivers of chronic illness, creating a feedback loop where the cost of care contributes to the very conditions that necessitate more care.

A Burden Shared Across Incomes

One of the most revealing aspects of the Gallup research is that the healthcare crisis is not confined to those living below the poverty line. While it is true that low-income households are hit hardest—55% of those earning less than $24,000 annually reported making trade-offs—the financial strain is spreading up the income ladder rapidly.

Even in households earning between $90,000 and $120,000 per year, 25% of adults reported making trade-offs to afford care. Perhaps most shocking is the impact on the wealthy: 11% of Americans in households earning $240,000 or more annually still make financial sacrifices to cover medical costs. This suggests that the cost of modern medicine, particularly for chronic conditions or specialized procedures, has outpaced even the growth of high-level professional salaries.

The presence of health insurance offers a shield, but it is increasingly thin. While 62% of the uninsured made trade-offs, nearly three in ten (29%) of those with health insurance still had to sacrifice basic needs. High-deductible health plans, which have become the standard in the private market, often leave families responsible for thousands of dollars in costs before their insurance begins to pay a cent. For a middle-class family, a single emergency room visit or a surprise diagnosis can still result in a financial catastrophe despite being “covered.”

Postponing the American Dream

Beyond the daily sacrifices, healthcare costs are now dictating the long-term life decisions of Americans. The Gallup study found that 53% of middle-income households have postponed at least one major life event in the past 4 years due to medical expenses.

The data on these delays is staggering:

• Postponing Vacations (29%): While often seen as a luxury, the inability to take time off for rest and family connection contributes to the national burnout crisis and declining mental health.
• Delaying Medical Treatment (26%): In a tragic irony, over 69 million Americans are delaying the very treatments they need—such as surgeries or diagnostic tests—because they cannot afford the associated costs. This delay often leads to more severe complications down the line, ultimately increasing the cost to the system and the risk to the patient.
• Changing Jobs (18%): Millions of workers feel “locked” into their current roles because of the fear of losing specific health benefits, a phenomenon known as “job lock.” This stifles economic mobility and prevents workers from seeking better opportunities or starting their own businesses.
• Buying a Home (14%): For nearly 37 million people, the dream of homeownership is being deferred as savings are diverted to pay for healthcare.
• Delaying Retirement (9%): An estimated 24 million Americans are working longer than they planned, not out of a desire to remain in the workforce, but because they cannot afford the cost of healthcare in retirement or are waiting to become eligible for Medicare.

These delays have a secondary impact on the broader economy. When 16 million people postpone having or adopting a child due to medical costs, it affects national demographics and future labor markets. When millions delay buying homes or starting businesses, it slows the overall pace of economic growth.

The Policy Cliff and Regional Inequities

The timing of this crisis is particularly precarious. The 2026 outlook is darkened by the expiration of enhanced subsidies for the Affordable Care Act (ACA), which helped millions of middle-income families afford premiums. Additionally, massive “unwinding” of Medicaid enrollment has left many who qualified during the pandemic without any coverage at all.

Geography also plays a critical role in how Americans experience these costs. Gallup’s state-level analysis shows that residents in bottom-ranked states are nearly twice as likely to stretch prescriptions or borrow money compared to those in top-ranked states like Massachusetts or Iowa. However, even in the best-performing states, roughly 10% of the population is still struggling. This indicates that while state-level policies can mitigate the crisis, the fundamental drivers of high costs are national in scope.

The True Cost of Inaction

The data provided by the West Health-Gallup Center on Healthcare in America serves as a warning. When a third of a nation’s population is forced to choose between their health and their electricity bill, the “system” is no longer functioning for the people it serves.

Healthcare affordability is often discussed in terms of policy papers and budget spreadsheets, but for 82 million Americans, it is a lived reality of skipped meals and borrowed money. The long-term health consequences of delaying 69 million medical procedures or rationing 39 million prescriptions will eventually manifest in higher mortality rates and even higher systemic costs.

As the U.S. approaches future legislative cycles, the findings from Gallup suggest that incremental tweaks may no longer be sufficient. The widespread nature of this struggle—touching every income bracket and every state—underscores that healthcare affordability is now a central economic and societal challenge. Without significant reform to address the underlying costs of care and the structures of insurance, the “trade-offs” Americans are making today may become the permanent sacrifices of tomorrow.

Sources

• Gallup: One-Third of Americans Cut Back to Cover Healthcare Expenses https://news.gallup.com/poll/702596/one-third-americans-cut-back-cover-healthcare-expenses.aspx
• West Health-Gallup Center on Healthcare in America: West Health-Gallup Affordability Index https://www.westhealth.org/press-release/west-health-gallup-2024-healthcare-affordability-index/