By Joe Paradza  |  Allied Health Leader & Healthcare Economics Analyst  |  Therapy Insights  |  April 2026

How many Americans cannot afford healthcare? A growing body of data points to a number that is both striking and rising. According to recent survey data from the Kaiser Family Foundation, roughly one in four American adults report that they or a family member have delayed or gone without needed medical care in the past year due to cost.

The United States spends more on healthcare per capita than any other high-income nation. Yet millions of Americans, insured and uninsured alike are making an impossible calculation every month: pay the medical bill or pay the rent.

That calculation is reshaping healthcare behaviour nationwide, with consequences that extend far beyond individual patients into emergency rooms, workforce productivity, and the federal budget.

The scale of the problem has been documented consistently across multiple independent sources.

The Centers for Disease Control and Prevention (CDC) reported that approximately 9.2% of adults in the United States did not get needed medical care due to cost in 2022 a figure that has held stubbornly above pre-pandemic levels.

Gallup polling consistently finds that healthcare affordability ranks among the top financial concerns for American households, with cost cited as the primary barrier to care access among low- and middle-income adults.

The Commonwealth Fund's 2024 International Health Policy Survey found that the U.S. has the highest rate of cost-related access problems among 11 comparable high-income nations. Adults in the U.S. were significantly more likely than those in the U.K., Australia, or Germany to skip a recommended test, treatment, or follow-up visit due to cost.

Even among the insured, the problem is significant. Rising deductibles now averaging over $1,700 for single coverage in employer-sponsored plans according to KFF mean that having insurance no longer guarantees affordable care. Analysts describe this as being "insured but unaffordable."

When Americans cannot afford healthcare, the response is predictable and measurable. Across income levels, people are making deliberate decisions to delay or avoid care entirely.

A 2023 Gallup survey found that 38% of Americans reported putting off medical treatment for themselves or a family member due to cost in the previous year the highest proportion recorded in Gallup's tracking of this issue since 2001.

The pattern is not limited to the uninsured. Middle-income families with employer-sponsored coverage report skipping care at significant rates when faced with high deductibles or unexpected out-of-pocket expenses.

The consequences of Americans skipping healthcare due to cost are not abstract. They translate directly into disease progression, preventable hospitalisation, and higher long-term spending explored in the next section and in more detail at Delayed Medical Care: Consequences and Health Risks.

The healthcare system is built on an implicit assumption: that patients will seek care when symptoms arise. When cost prevents that, a chain of delayed care consequences begins.

Conditions caught early are, in most cases, significantly less costly and more treatable than those diagnosed at an advanced stage.

"When patients delay care due to cost, we often see them again in the emergency department - sicker, and more expensive to treat," said one hospital administrator quoted in a 2023 Health Affairs analysis of cost-related care avoidance.

A counterintuitive outcome of deferred care is higher total expenditure. Preventive visits and early treatment are cheap relative to emergency intervention.

Research published in the American Journal of Managed Care estimates that preventable hospitalisation largely driven by delayed care consequences costs the U.S. healthcare system tens of billions of dollars annually. Patients bear a share of that burden through emergency department co-pays, inpatient billing, and lost income during recovery.

For a detailed breakdown of what delayed medical care means across specific conditions, see: Delayed Medical Care: Consequences and Health Risks.

It is tempting to frame cost-related care avoidance as a personal budgeting problem. The data does not support that framing.

The healthcare affordability crisis in the USA is the product of structural forces — not individual choices. Three interlocking pressures have made care increasingly inaccessible for a growing share of the population.

Even with insurance, American patients face deductibles, co-pays, coinsurance, and non-formulary drug costs that can push total out-of-pocket exposure into thousands of dollars per year. The average deductible for employer-sponsored single coverage crossed $1,700 in 2023, double what it was a decade earlier.

Despite the Affordable Care Act's expansion of coverage, an estimated 25–30 million Americans remain uninsured, according to U.S. Census Bureau data. Many others are underinsured, meaning their coverage provides insufficient financial protection against significant medical events.

For millions of households, healthcare competes directly with housing, food, and fuel costs. Following years of inflation that elevated the cost of essentials, discretionary health spending, routine appointments, dental care, vision is frequently cut first.

This crisis extends beyond U.S. borders. An analysis of how cost pressures are affecting patient behaviour in comparable economies is available at Skipping Healthcare Due to Cost: A Global Crisis in 2026.

The effects of the healthcare affordability crisis in the USA extend well beyond individual patients. They are reshaping how the system operates and straining it in ways that affect everyone.

When primary and preventive care becomes unaffordable, emergency departments absorb the overflow. Patients presenting with advanced, preventable conditions consume disproportionate resources contributing to the wait times, staffing pressures, and per-patient costs that affect all ED users.

Poor health outcomes driven by delayed care reduce workforce participation. Chronic conditions left untreated result in missed workdays, reduced productivity, and early workforce exit outcomes that carry measurable economic costs for employers and the broader economy.

Paradoxically, under-treatment today generates higher spending tomorrow. Every unmanaged chronic condition is a deferred bill one that is typically paid at a higher rate when it surfaces as an emergency, hospitalisation, or disability claim.

Estimates from the Milken Institute suggest that lost economic productivity due to preventable chronic disease costs the U.S. economy over $1 trillion annually. The connection between that figure and cost-driven care avoidance is direct.

Experts and analysts tracking U.S. healthcare trends do not project a near-term reversal of current conditions.

Out-of-pocket costs are projected to continue rising, driven by ongoing pharmaceutical price increases, labour costs in healthcare, and insurance premium adjustments. The proportion of Americans unable to afford healthcare is unlikely to decline without significant policy intervention.

Healthcare analysts warn that sustained avoidance of preventive care is building a deferred disease burden, a wave of patients who will re-enter the healthcare system at higher acuity, straining capacity and cost structures. Particular concern centres on cardiovascular disease, diabetes, and mental health conditions.

The long-term implication of the current trajectory is a deepening of access inequality. Higher-income households absorb rising costs; lower- and middle-income households exit the system. The result is a bifurcated healthcare landscape in which financial position not clinical need determines who receives care.

Policy responses under discussion include expanded Medicaid eligibility, pharmaceutical price negotiation reform, transparency requirements for hospital pricing, and cap structures on out-of-pocket exposure. Whether and when these translate into enacted policy will determine the trajectory of the access crisis.

How many Americans cannot afford healthcare? The answer, across multiple reliable data sources, is tens of millions and the number is not declining.

What this data describes is not a fringe problem or an edge case. It is a mainstream experience for working adults across income brackets, insurance statuses, and geographies. The decision to skip a test, ration medication, or delay a specialist visit is being made in homes across the country with consequences that compound quietly over time.

The healthcare affordability crisis in the USA is documented, measurable, and worsening. Understanding the scale of the problem is the first step toward demanding that it be addressed.