One in Three Americans Is Now Cutting Spending Just to Afford Healthcare — Here Is What That Actually Looks Like

Disclaimer: This article is for informational purposes only and does not constitute medical or financial advice. Consult your healthcare provider and a licensed financial advisor for personal guidance. Sources include Gallup, the Centers for Medicare and Medicaid Services (CMS), the Kaiser Family Foundation (KFF), the Bureau of Labor Statistics (BLS), and the Commonwealth Fund.

I read a lot of health statistics. Most of them blur together after a while — percentages and trend lines that feel abstract until they show up in your own life. But a recent Gallup survey stopped me cold: roughly one in three American adults has cut spending on food, utilities, or other essentials — or borrowed money — just to cover healthcare costs in the past year.

That is not a number. That is a crisis hiding in plain sight behind co-pay statements and explanation-of-benefits letters that nobody reads.

Healthcare Costs Are Forcing Americans to Make Impossible Choices

Gallup has been tracking healthcare cost burden for over two decades. The trend has been heading in one direction: up. In 2022, 38 percent of Americans reported postponing medical treatment due to cost — the highest reading in the survey history and a 12-point jump from the prior year. By 2025, supplementary data from the Commonwealth Fund and KFF confirmed that the problem had not improved. If anything, it had gotten worse.

Dr. Patel, a primary care physician I have been interviewing periodically for this site (she runs a practice in suburban Ohio and insists on being quoted as "someone who sees this every single day"), described what cost-driven care avoidance looks like on the ground. "I had a patient last month — 54 years old, diabetic, employed full-time with insurance — who was rationing her insulin because the co-pay went from $35 to $110 after her employer switched plans in January. She was taking half doses. Half. Of insulin."

That is not an edge case. A 2024 KFF Health Care Debt Survey found that 100 million Americans carry some form of medical debt. Roughly 1 in 5 households with health insurance still owed money from medical bills they could not pay in full.

Where the Money Actually Goes

Understanding why healthcare costs are crushing household budgets requires looking at where the spending increases are coming from. The Bureau of Labor Statistics reported that healthcare spending per consumer unit hit $6,032 in 2024, up from $5,850 the previous year. But that average masks enormous variation:

• Insurance premiums: The average employer-sponsored family plan now costs $25,572 per year, according to KFF. Workers pay roughly $7,000 of that out of pocket before they use a single service.
• Deductibles: The average individual deductible for employer-sponsored plans hit $1,735 in 2024. For many workers, that means the first $1,735 of care each year comes entirely out of their checking account.
• Prescription drugs: Even with the Inflation Reduction Act capping Medicare drug costs at $2,000 per year starting 2025, workers under 65 with commercial insurance still face uncapped pharmacy costs. Specialty drugs routinely run $500 to $2,000 per month in co-pays.
• Surprise bills: Despite the No Surprises Act, billing disputes and out-of-network anesthesiologist charges continue to generate unexpected costs that catch families off guard.

Sandra, a health data analyst who left the insurance industry after 11 years (she told me the final straw was watching a claim denial algorithm reject a cancer screening for a 46-year-old because it was "not age-appropriate"), put it simply: "The system is designed to collect premiums and minimize payouts. Everything else is a feature, not a bug."

The Health Consequences of Avoiding Healthcare

Here is what keeps doctors like Dr. Patel up at night: when people skip or delay care because of cost, conditions that are cheap to treat early become expensive emergencies later. A $200 blood pressure medication skipped for six months can lead to a $47,000 stroke hospitalization. A $150 mammogram delayed for two years can mean the difference between Stage I and Stage III breast cancer — and a cost difference measured in hundreds of thousands of dollars.

The CDC estimates that chronic diseases account for 90 percent of the $4.5 trillion the US spends on healthcare annually. Many of those chronic conditions — hypertension, Type 2 diabetes, high cholesterol — are manageable with early intervention and consistent medication. When patients ration or skip treatment, the system pays exponentially more down the road.

Tom, a hospital administrator who has been in healthcare operations for 19 years (and who tracked his own facility emergency room visits on a spreadsheet that now has 4,380 rows), shared a pattern he sees repeatedly. "We get the same patients cycling through the ER every few months. They cannot afford their maintenance medications, so they come in when things get critical. Each ER visit costs us $3,200 on average. The medications they cannot afford? Usually $40 to $120 a month. The math is insane."

Who Gets Hit Hardest

Gallup data consistently shows that lower-income Americans, women, and younger adults are most likely to delay care due to cost. But the problem has been creeping upward into middle-income households that previously considered themselves financially secure:

• Households earning $40,000-$75,000: The fastest-growing segment reporting healthcare cost burden, according to KFF.
• Uninsured adults: Still 27.6 million strong as of 2024 (Census Bureau), despite Medicaid expansion and ACA marketplace subsidies.
• Gig workers and contractors: An estimated 73 million Americans in 2024 did some form of freelance work, many without employer-sponsored health benefits.
• Seniors on fixed incomes: Even with Medicare, out-of-pocket costs for beneficiaries averaged $7,000 per year in 2024, per the Commonwealth Fund.

What You Can Actually Do About It

I am not going to pretend there is a simple fix for a structural problem this large. But there are concrete steps that can reduce your household exposure to healthcare cost shocks:

1. Review your plan during open enrollment like it is a tax return. Compare total cost of care — premiums plus expected out-of-pocket — not just the monthly premium. A higher-premium plan with lower deductibles often saves money if you use services regularly.
2. Ask about cash-pay prices. Many providers offer a cash discount that is 30 to 60 percent lower than the insurance-negotiated rate, especially for imaging and lab work. Always ask before you schedule.
3. Use patient assistance programs. Nearly every major pharmaceutical company runs one. NeedyMeds (needymeds.org) maintains a searchable database of over 17,000 programs. Dr. Patel told me she estimates half her patients who qualify for assistance do not know these programs exist.
4. Negotiate hospital bills. A 2023 JAMA study found that 57 percent of patients who negotiated their hospital bills received a reduction. The average reduction was 34 percent. Call the billing department. Ask for a financial hardship application. It works more often than you think.
5. Check for preventive care coverage. Under the ACA, most insurance plans must cover a list of preventive services — including vaccinations, cancer screenings, blood pressure checks, and depression screening — at zero cost sharing. Use them.

Rachel, a benefits consultant who works with small businesses (she told me she once spent 47 minutes on hold with an insurance carrier and used the time to reorganize her sock drawer), summed it up with a frustration I suspect many readers share: "The system makes it deliberately hard to be a smart consumer. But the people who put in the work — who compare plans, who negotiate, who ask for generic alternatives — save thousands. It should not be that hard. But it is. So you have to play the game."

She is right. It should not be this hard. But until something changes at the structural level, protecting your health means protecting your wallet — and vice versa.

Sources: Gallup Health and Healthcare Poll, Kaiser Family Foundation (KFF), Commonwealth Fund, Centers for Medicare and Medicaid Services (CMS), Bureau of Labor Statistics (BLS), Census Bureau, CDC Chronic Disease Prevention, JAMA, NeedyMeds.org.