Why Millions of Americans Are Struggling to Afford Health Care in 2026
Health care affordability is not an abstract policy debate for most people. It is a monthly math problem that is getting harder to solve. A KFF data note updated April 30, 2026, titled Americans’ Challenges with Health Care Costs, pulls together KFF’s recent polling to show just how widespread that struggle has become, from skipped prescriptions to unpaid medical bills. This post walks through what the data actually says and what a reader facing these pressures can realistically do about it.
How many Americans worry about affording health care costs right now?
Health care costs have climbed to the top of the list of household financial worries. Nearly two-thirds (64%) of adults are worried about being able to afford health care costs, on par with the share who now worry about gas and transportation costs (64%) and outranking other economic concerns like groceries, utilities, and housing. Three in ten adults (30%) say they are “very worried” about paying for health care, not just somewhat concerned.
This isn’t a fleeting concern tied to a single event. KFF’s data frames the problem plainly: health care costs remain at the top of the list of people’s financial worries, with nearly two-thirds saying they are at least somewhat worried about affording the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs for themselves and their families.
How many people are skipping care because of cost?
Worry translates directly into behavior. One-third (36%) of adults say they have skipped or postponed getting needed health care in the past 12 months because of the cost. The consequences are real: nearly two in ten adults (18%) report their health got worse because they delayed or skipped care. Women are more likely than men to report skipping needed care due to cost (38% vs. 32%), and adults 65 and older, most of whom are covered by Medicare, are much less likely to report this than younger age groups.
What is happening with prescription drug costs specifically?
Medication is often where cost-cutting shows up first. About four in ten adults say that in the past year they did not take their medicine as prescribed due to cost, including taking an over-the-counter drug instead of filling a prescription, not filling a prescription at all, or cutting pills in half or skipping doses. The burden falls unevenly: 58% of uninsured adults under 65 report these prescription cost-cutting measures compared to 43% of insured adults. Women (49%) are more likely than men (36%) to report using these measures.
How much medical debt are Americans carrying?
Cost pressure does not stop at skipped care. It frequently turns into debt. KFF’s Health Care Debt Survey finds that 41% of adults currently have some form of debt caused by their own or a family member’s medical or dental bills. A separate Peterson-KFF Health System Tracker analysis of federal survey data estimates that people in the United States owe at least $220 billion in medical debt.
Many households have little room to absorb a surprise bill. About half of U.S. adults say they would not be able to pay an unexpected medical bill of $500 out of pocket. Adults who went without health insurance for part of the year are most likely to report medical debt (about 14%), compared with 8% of those insured all year. Adults with incomes below 400% of the federal poverty level are more likely to report significant unpaid medical bills than higher-income adults.
Does having insurance protect you from these costs?
Coverage helps, but it does not eliminate the burden. Among insured adults, satisfaction with what they pay is mixed: most insured adults rate their health insurance as excellent or good when it comes to out-of-pocket costs for prescriptions (61%), doctor visits (53%), and monthly premiums (54%). That still leaves large minorities, in some cases close to half, who rate their coverage’s affordability as fair or poor.
The picture looks tougher for people who buy their own coverage on the ACA Marketplace. Six in ten adults (61%) who buy Marketplace coverage say it is very or somewhat difficult to afford their deductibles and out-of-pocket costs, and half (51%) say it is difficult to afford monthly premiums. Nearly six in ten Marketplace enrollees say they would not be able to afford an annual increase of $300 in health care expenses without significantly disrupting their household finances.
What is happening to ACA Marketplace enrollees in 2026 specifically?
This affordability squeeze has intensified because of a specific policy change. According to KFF’s July 2026 analysis of 2026 ACA Marketplace enrollment, average monthly effectuated enrollment could fall to about 17.5 million people in 2026, down from 22.3 million in 2025, following the expiration of enhanced premium tax credits at the end of 2025. Enrollee premiums rose an average of 58%, from $113 to $178 per month, and average Marketplace deductibles grew by 37%, or $1,027 per person, to a record $3,786 in 2026.
Many enrollees responded by trading premium relief for higher cost-sharing. Among returning Marketplace enrollees who switched plans, 54% say their deductibles are higher this year, including 34% who say a lot higher, and 42% say their coinsurance and copays are also higher. The hospital system is feeling it too: a recent surge in uninsured patients at major hospital systems has confirmed what the enrollment data suggests, that most people who lost ACA coverage did not find another plan. They became uninsured entirely.
Out-of-pocket spending has also climbed for people with employer coverage. According to the Peterson-KFF Health System Tracker, out-of-pocket spending per person reached $1,514 in 2023, up from an inflation-adjusted $703 in 1970. That spending is heavily concentrated among people with high medical needs: in 2022, people in the top 1% of out-of-pocket spending paid about $23,700 per year on average.
What are your options if health care costs are becoming unaffordable?
None of this data points to a single fix, because health coverage is not a single product. If you are weighing your options, it is worth looking at the realistic range rather than defaulting to whatever plan you had last year.
For most people who do not have an employer plan, an ACA Marketplace plan is still the starting point, especially if your income qualifies you for premium tax credits. Given the premium and deductible increases described above, it is worth running the actual numbers for your household rather than assuming last year’s plan is still the best fit.
If a full ACA plan does not pencil out and you are weighing something different, health sharing has become a genuine option for a meaningful number of households. Modern Health Sharing is a health sharing arrangement that combines community cost sharing with real advocacy support, helping members navigate the healthcare system as self-pay patients, access transparent pricing, reduce overall healthcare spending, and understand their bills, all in one coordinated approach. Members contribute monthly and the community helps pay eligible medical bills, which typically means a lower monthly cost than a comparable insurance premium and real financial protection for a major medical event like a hospitalization or surgery.
The honest trade-off is that a health share is not insurance: it does not guarantee payment of any specific bill, coverage runs according to each organization’s Member Guidelines, and pre-existing conditions are usually subject to a waiting period before they are eligible for sharing. Many members pair a health share with a Direct Primary Care membership, which covers routine primary care visits for a flat monthly fee, so day-to-day care is predictable while the health share handles larger, unexpected bills. Together, this Modern Healthcare Cooperative approach, a complete coverage strategy combining health sharing, preventive care, a health savings account, and a dedicated team to help members navigate the healthcare system as self-pay patients, can represent a meaningfully lower-cost and more responsive alternative for healthy individuals and families above the subsidy cliff.
Other options worth knowing about depending on your situation include short-term medical insurance for a temporary coverage gap, MEC (minimum essential coverage) plans, indemnity benefit plans that pay fixed cash benefits for specific events, and COBRA if you are transitioning out of an employer plan. If your employer offers it, an ICHRA lets an employer reimburse you tax-free for an individual plan you choose yourself. Because none of these options fit every situation, the most useful next step is usually to compare your coverage options by state and income before deciding.
Frequently Asked Questions
What percentage of Americans are worried about affording health care in 2026? According to KFF’s April 2026 data note, nearly two-thirds (64%) of adults say they are worried about being able to afford health care costs, a share now tied with worry about gas and transportation costs and higher than worry about groceries, utilities, or housing.
How many people skip medical care because they cannot afford it? KFF’s Health Tracking Poll found that about one-third (36%) of adults say they skipped or postponed needed health care in the past 12 months because of the cost, and nearly one in five adults (18%) say their health got worse as a result of delaying care.
Do insured people also struggle to afford health care? Yes. KFF polling shows large shares of insured adults, roughly four in ten to half depending on the specific cost category, do not rate their out-of-pocket costs for doctor visits, prescriptions, or premiums as excellent or good. Among ACA Marketplace enrollees specifically, about six in ten say it is difficult to afford their deductibles and out-of-pocket costs.
How much medical debt do Americans have? KFF’s Health Care Debt Survey found that 41% of adults currently carry some medical or dental debt, and a separate Peterson-KFF Health System Tracker analysis estimates that people in the U.S. owe at least $220 billion in medical debt overall.
Why did ACA Marketplace premiums rise so much in 2026? The enhanced ACA premium tax credits that had lowered monthly premiums since 2021 expired at the end of 2025. KFF’s analysis found enrollee premiums rose an average of 58%, from $113 to $178 per month, and effectuated Marketplace enrollment could fall to roughly 17.5 million people in 2026, down from 22.3 million in 2025.
Is a health share a realistic alternative to an ACA plan in 2026? For a healthy individual or family above the ACA subsidy cliff who is paying full, unsubsidized price for Marketplace coverage, a well-established health sharing organization with a long operating history and transparent Member Guidelines is worth comparing seriously. A Modern Health Sharing arrangement paired with Direct Primary Care addresses both the routine and major medical coverage gaps at a typically lower monthly cost than an unsubsidized ACA premium. Health shares are not insurance, and pre-existing conditions are typically subject to waiting periods, so this option fits best for people without current ongoing specialist needs.
This article is for general informational purposes only and is not insurance, legal, or financial advice. Figures on worry, skipped care, medication cost-cutting, and medical debt come from KFF’s Americans’ Challenges with Health Care Costs data note (updated April 30, 2026) and the underlying KFF Health Tracking Polls it draws on, along with the separate KFF Health Care Debt Survey and Peterson-KFF Health System Tracker analyses. ACA Marketplace enrollment and cost figures come from KFF’s 2026 Marketplace enrollment analyses published May and July 2026. Always confirm your specific eligibility, premium, and subsidy amount at HealthCare.gov or your state’s Marketplace before making a coverage decision.
By the Modern Healthcare Works team