In 2025, Gallup found that fewer than half of U.S. adults can consistently afford needed care, raising the stakes for employers making benefits decisions in a cost-pressured environment.
The West Health-Gallup Affordability Index now finds that just 49% of U.S. adults are "cost secure," meaning they can access quality, affordable care and pay for needed care and prescriptions. That share is down 12 points since 2022 and 2 points from 2024, continuing a steady decline.
At the other end, 41% of adults are now "cost insecure," meaning they lack affordable access to care or have recently struggled to pay for care or prescriptions. Another 10% are "cost desperate," meaning they face both barriers at once.
The report points to several factors behind declining affordability, with prescription drug costs standing out. Today, 42% of Americans are concerned about affording prescriptions, up from 30% in 2021, and medication costs are now a major driver of cost insecurity.
The data also shows meaningful gaps by gender and health status. Women are disproportionately represented among cost-insecure adults, facing greater barriers to care and paying for needed services.
The index also found that adults with chronic conditions are less likely to be cost secure. Mental health is another pressure point: more than 6 in 10 adults with anxiety or depression struggle to afford care and prescriptions, which can make those conditions harder to manage. Download the bulletin for more details.