Nearly half of adults are worried they will not be able to afford necessary healthcare in the coming year, according to a new nationwide survey from the West Health-Gallup Center for Healthcare in America. The findings reflect the highest level of cost anxiety since tracking began in 2021 and offer a detailed look at how residents across all 50 states are experiencing the system.
The inaugural State of the States 2025 report paints a picture of widespread concerns around affordability, access and quality, with substantial variation depending on where people live.
By the numbers: The national numbers highlight the daily stress many households face:
- 47% of adults worry about affording needed healthcare in the next year.
- One in five households could not pay for prescription medications in the last three months.
- 30% of adults say someone in their household skipped medical treatment due to cost.
State-level disparities are significant. In Iowa, 12% of adults said they could not afford a prescription in the past three months. In Mississippi, that figure is 36%. Massachusetts reports the lowest rate of residents skipping treatment due to cost at 18%, compared with 46% in Mississippi.
Quality and access vary widely: The study also evaluates states based on quality and access:
- Quality: While 71% of adults nationally say their provider ensures they receive recommended screenings, that climbs to 78% in Massachusetts and Rhode Island and drops to 59% in Oregon and Wyoming.
- Access: Long appointment wait times are the most common barrier. Fifty-three percent of adults nationwide say delays kept them from receiving care. Vermont reports the highest share at 72%. Nebraska, which ranks strongest on access, still reports 46%.
Residents in top-ranked states are less likely to skip recommended care and are more likely to report proactive provider engagement, but even top-performing states show warning signs.
The overall rankings place Iowa and Massachusetts at the top for healthcare experience across cost, quality and access. Alaska, Arkansas and Texas occupy the bottom spots. Yet even in high-performing states, thousands of residents struggle to get or afford care.
The report card tells a similar story. Americans gave the national healthcare system an overall grade of C, with cost earning a D+. Not a single state scored an A in any category.
