Stress Prominent Among U.S. Adults Struggling to Pay for Care

3 min
December 05, 2022
Editor’s Note: The research detailed below was conducted in partnership with West Health, a family of nonprofit and nonpartisan organizations focused on lowering healthcare costs to enable successful aging.

By Dan Witters and Nicole Willcoxon

Seven percent of U.S. adults, representing an estimated 18 million people, report recently being unable to pay for care or medicine for themselves or their families and lacking access to affordable quality care if it were needed today. The large majority of these people report that healthcare prices today are a daily source of stress.

These latest findings are based on a new analysis of the West Health-Gallup Healthcare Affordability Index and the Healthcare Value Index, which are periodically updated and drawn from the opinions of nearly 5,600 American adults. West Health and Gallup developed the indices after 30% of Americans reported that they had to skip needed medical care due to cost in 2021.

The Healthcare Affordability Index evaluates three key factors in determining the ability of Americans to afford healthcare: (1) avoiding treatment due to cost, (2) forgoing prescribed medication or drugs due to cost, and (3) having immediate access to affordable quality healthcare.

Based on these three metrics, Americans fall into three categories:

  • cost secure individuals (61% of the U.S. adult population), who report no recent occurrences of being unable to afford healthcare or prescribed medicine in their household and have access to quality care if it were needed today
  • cost insecure individuals (32% of the U.S. adult population), who report recent occurrences of being unable to pay for care or medicine or lack access to quality healthcare
  • cost desperate individuals (7% of the U.S. adult population), who report recent occurrences of being unable to pay for care or medicine for themselves or members of their household and lack access to affordable quality care if it were needed today

Cost Desperate Americans Worry About Affordability of Future Care

Among the estimated 18 million Americans who are considered cost desperate, 92% are “not very” or “not at all” confident that they will have the funds to pay for treatment as they age. Additionally, 94% of cost desperate Americans report that healthcare prices are a daily source of stress.

Similarly, cost insecure Americans report high daily healthcare-related stress and low confidence in their ability to pay for future healthcare. Three-quarters don’t have faith in their financial outlook when it comes to healthcare, and a sizable majority (62%) feel daily stress due to healthcare costs.

For those classified as cost secure, over a third (36%) lack confidence in paying for care as they age, and 23% say healthcare costs cause daily stress.

Cost Desperate Americans Disproportionately Women, Hispanic

The Healthcare Affordability Index demonstrates the range in how Americans suffer the cost of care. Roughly three-quarters (76%) of cost desperate American households earn less than $90,000 annually. However, other demographic groups reveal even broader inequities than income. Women and Hispanic adults are disproportionately classified as cost desperate relative to their share of the U.S. adult population. Fifty-seven percent of cost desperate Americans are women, and 25% are Hispanic, despite making up 51% and 17% of the population, respectively. Cost insecure adults are composed of 60% women and 20% Hispanic Americans.

Cost desperate Americans are more likely to have multiple chronic conditions than the overall population. Forty-eight percent have three or more chronic conditions, compared with 36% of all U.S. adults.

Americans Perceiving Poor Value of Care Are Also Stressed

The Healthcare Value Index classifies respondents based on their perceived value of care and shows that few Americans believe they get good value when they weigh the quality of their care against the amount that they pay for it. This index shows that adults who view the U.S. healthcare system in terms of “poor perceived value” (36% of all adults) express the highest level of daily stress due to its costs, with almost two-thirds (59%) saying it’s a source of stress in their daily lives. Only 7% of Americans are classified as observing “high perceived value” regarding the U.S. healthcare system, while the majority (57%) are classified as observing “inconsistent perceived value.”


Overwhelmingly, cost desperate Americans lack confidence in their ability to pay for their healthcare as they age, suffer daily stress from a high-priced health system, and are disproportionately women and Hispanic Americans. That 7% of U.S. adults perceive healthcare as “high value” underscores widespread public discontent with the quality of care Americans receive relative to the cost.

While the West Health-Gallup indices were originally designed to track people’s experience with the healthcare system, they also offer a glimpse of Americans’ emotional and mental wellbeing. The great extent to which the odds of health and life outcomes vary based on people’s experiences with the U.S. healthcare system validates the usefulness of the indices in practical terms. Access to healthcare, for example, is part of the original conceptualization of the Gallup National Health and Well-Being Index and is closely intertwined both with emotional and physical health as well as general life ratings. Holistic wellbeing, in turn, is closely associated with hospital admissions and is proven to have a strong causal impact on the future condition of an array of physical and mental health disease states.

With healthcare costs expected to climb 66% from $4.1 trillion in 2020 to $6.8 trillion by 2030, daily stress and worry about future healthcare costs could similarly rise. Policies that reduce healthcare costs benefit not only the financial wellbeing of Americans but their emotional wellbeing as well.


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