Americans are struggling to pay for health care. Here's why

Stacy Cox and her husband are self employed, so they don’t get health insurance through an employer.

The Utah couple relied on enhanced Affordable Care Act subsidies to reduce their insurance bill to $500 a month in 2025. When Congress failed to extend the subsidies last year, their monthly insurance bill soared to more than $2,100.

It was too much.

“We’re caught in the middle,” Cox said. “We make too much money to qualify for any additional assistance. But we don’t make enough money to afford a $2,100 per month premium.”

More Americans are struggling to pay for health insurance, medical bills and prescription drugs. Fewer than half of adults said they believed they could pay for health care, medical appointments and prescriptions, according to the West Health-Gallup’s affordability index published on June 18.

Another 41% of Americans were “cost insecure” because they either lacked access to affordable care or couldn’t pay for care or medicine, according to West Health-Gallup, which based its findings on a survey of 5,660 adults aged 18 and older.

At a time when prices for health insurance and medical care are outpacing the rate of inflation and wage growth, other research shows people are struggling to afford living expenses and routine doctor appointments or needed prescriptions.

A Harris Poll survey for the American Heart Association released this month found half of U.S. workers said health care costs have made it difficult to afford living expenses, including child care, food and rent. And research by the Urban Institute released June 10 found 46% of working-age adults in the United States struggled to afford health care for their families.

Ellyn Maese, research director for the West Health-Gallup Center on Healthcare, said her group's survey underscores how Americans are struggling to afford rising health expenses.

"Less than half of the nation is saying that they are able to consistently afford medication, visits and access to quality care," Maese said, noting it's the first time West Health-Gallup reported less than 50% of adults were secure about health costs.

Rising insurance premiums, higher prescription costs

The Centers for Medicare & Medicaid Services on Jan. 28 reported about 23 million Americans signed up for ACA coverage in 2026, down from 24.2 million signups as of January 2025. However, the number of people who dropped ACA coverage won't be known until CMS reports more robust enrollment figures later this year.

While the expiration of the enhanced ACA subsidies made insurance more expensive for millions of consumers, experts say other health costs, such as prescription drugs, medical tests and hospital bills, are also squeezing consumers.

Employers who provide health insurance for most working-age Americans are dealing with escalating costs. Companies expect to spend an average of $18,500 per employee for health insurance in 2026, an increase of 6.7% from a year ago, according to the consultant Mercer.

"This is not about any one bad actor," said Howard Forman, a Yale School of Management professor and a physician. "This is about a system that ultimately leads us to spend more and more over time. We have not had the type of reckoning in this country that we need to have."

'Have we reached the pain point yet?'

When Cox, 49, and her husband, John Crowley, 55, discovered their ACA insurance costs were set to more than quadruple, they searched for less expensive options and settled on a short-term insurance plan that cost $565 per month.

Short-term plans typically charge less expensive monthly premiums, but often lack protections for consumers who buy their own health insurance.

Short-term plans don’t cover existing medical conditions or preventive care. And the plan Cox and Crowley chose came with a $10,000 deductible – the amount they must pay before coverage kicks in.

Cox and Crowley are healthy adults, but they are skimping on care and recommended medical tests because they can’t afford to pay the prices charged by health care providers. They are keeping the short-term plan as protection against a medical emergency.

Crowley had a recent medical scare when he developed leg pain and numbness. He delayed going to the doctor, but the pain became too much, Cox said. He needed an MRI, which an imaging center affiliated with the local health system said would cost $2,200 with insurance or $1,600 if he wanted to pay cash without using insurance.

Either way, he’d have to pay the full price because their insurance plan carries a $10,000 deductible. If he chose the less expensive $1,600 cash price, he was told that amount would not be applied toward his insurance plan’s deductible.

Cox said she was “irate” because the health system's imaging offered a discount of $600 if they didn’t submit paperwork to their insurance plan.

“It felt like extortion,” Cox said. “You’re going to take us for an extra $600 just so we could put that toward our deductible?”

They eventually found another imaging center in St. George, Utah, that would complete the MRI for $399. The lower price made it worthwhile for the couple to make the 90-minute drive to and from the center.

But the extra costs from their bare-bones insurance plan are squeezing their household finances. They've cut back on vacations, dining out and streaming services.

They've both built successful businesses that they love. She's a photographer, he's an audio engineer. But they're considering taking a corporate job, just to get employer-provided health insurance.

"We have a very good life. We make enough to pay for our mortgage, our cars, our car insurance," Cox said. "Every month, we come back to the table to say, 'Have we reached the pain point yet?' It's all because of health care."

Email Ken Alltucker at [email protected]