Article
What the survey found
The West Health-Gallup Center on Healthcare surveyed 5,660 adults late last year and published the results on June 17. Just 49% qualified as cost secure, down from a 2022 peak of 61%. Another 41% were cost insecure and 10% were classified as cost desperate. About 2.8 million more Americans fell out of the cost-secure group between 2024 and 2025.
The decline is broad. Among adults ages 18 to 29, only 32% are cost secure. Among those 65 and older, the share has fallen from 73% in 2021 to 61%. Women trail men by 15 points, the widest gap Gallup has recorded. Worry is rising, too: 51% are concerned about paying for needed services in the coming year and 42% about affording prescriptions, both record highs for the series.
Income still matters most. Only 23% of adults in households earning under $24,000 are cost secure, but the share of middle- and upper-middle-income adults who are not cost secure grew last year.
Why this lands on the board agenda
Affordability pressure shows up in hospital finances through delayed care, higher acuity on arrival, larger patient balances and growing bad debt. It also shapes how communities, employers and lawmakers view local health systems. When patients feel squeezed, scrutiny of prices, collection practices and charity care tends to follow, particularly for tax-exempt organizations.
Questions directors should ask
- Who is struggling? Break out patient balances, payment plans and financial assistance use by age, payer and service line.
- Is assistance easy to get? Review eligibility thresholds, presumptive screening and how clearly the policy is explained before and after care.
- How do we collect? Confirm that vendor and internal practices match the organization’s mission and that legal action against patients is rare and reviewed.
- Can patients see prices? Test whether estimates are accurate and available for common shoppable services.
- What is our story? Make sure community benefit reporting explains concrete actions on affordability, not just totals.
None of these steps fixes national cost trends, but each reduces the risk that affordability concerns turn into a reputational problem for the organization.
Archive entry for Jun 24, 2026, added Nov. 11, 2026.