Nearly half of working-age Americans struggled to afford healthcare in 2025, and more than one-third said someone in their family had unmet healthcare needs because of high costs.
“Affordability of healthcare is everyone’s concern, not just people who are uninsured,” said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation. “In addition to rising premiums, higher out-of-pocket costs make many people less secure and potentially less healthy as they avoid needed care.”
The foundation recently funded Urban Institute research on the affordability of U.S. healthcare. Although 60% of uninsured adults reported affordability challenges, many individuals with health insurance coverage also said their families faced high healthcare costs.
See also: ‘Time for employers to take action’ on soaring healthcare costs
Affordability challenges in healthcare not limited to the uninsured
Among people who get insurance through an employer, 4 in 10 cited affordability challenges, while 54% of those who purchase insurance on their own and 57% of people enrolled in Medicaid reported difficulty affording care. These findings show that healthcare affordability challenges are not limited to the uninsured, but also are common among those with insurance, researchers said.
The challenge of healthcare affordability was particularly pronounced for working-age adults with disabilities (69%), individuals in fair or poor health (65%) and people with chronic conditions. More than 6 in 10 individuals who had been diagnosed with a stroke, chronic obstructive pulmonary disease, cancer, heart disease or diabetes reported affordability challenges. More than half of Black and Hispanic adults, residents of Southern states and people in rural areas reported difficulty affording healthcare for themselves and their families last year.
Unmet healthcare needs were the most prevalent challenge faced by individuals and family members, regardless of insurance status. Other financial challenges included amassing medical debt and problems paying medical bills. Slightly fewer than 3 in 10 respondents reported their family had taken on debt to pay for medical care.
Researchers expect healthcare to become less affordable for working families in the coming years as new federally mandated Medicaid and Marketplace policies are projected to add millions to the ranks of the uninsured. Some working families who are not eligible for Medicaid have already experienced steep premium increases or higher deductibles for ACA Marketplace plans following the expiration of enhanced premium tax credits last year.
“These findings highlight widespread difficulty in affording healthcare across the United States,” said Michael Karpman, principal research associate at the Urban Institute. “Recent federal policy changes could exacerbate these difficulties by increasing the number of people who are uninsured. And if more employers shift the rising costs of healthcare to their employees, affordability challenges will increase.”
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