The share of Americans who can consistently afford healthcare fell to its lowest point in five years in 2025, a shift that points toward continued growth in the unpaid medical bills that collectors and healthcare providers must manage.
According to data released last week by the West Health-Gallup Center on Healthcare in America, 49% of U.S. adults were classified as “cost secure,” meaning they reported being able to pay for needed care, prescriptions and access to quality treatment. It marked the first time since the index began in 2021 that fewer than half of adults qualified. The findings draw on surveys of 5,660 adults conducted between Oct. 27 and Dec. 22.
Another 41% of adults were considered “cost insecure,” reflecting financial barriers to care or medication, while 10% were “cost desperate,” reporting multiple affordability and access challenges at once.
The downward trajectory has been steady. Cost security peaked at 61% in 2022 before sliding to 55% in 2023, 51% in 2024 and 49% last year. An estimated 2.8 million adults dropped out of the cost-secure category between 2024 and 2025 alone. Researchers noted the results predate the expiration of enhanced Affordable Care Act subsidies, which have since pushed premiums higher and could deepen the strain in future readings.
For the collections industry, the demographic detail matters. Adults ages 18 to 29 recorded the sharpest decline since 2021, with cost security falling from 46% to 32%, the lowest of any age group. The gender gap also widened to its largest on record, with 42% of women cost secure compared with 57% of men. Even higher earners felt pressure, as roughly a third of households earning between $120,000 and $179,999 were not cost secure.
Forward-looking anxiety is climbing as well. In 2025, 42% of respondents said they worried about affording prescription drugs and 51% expressed concern about paying for healthcare services, up from 36% and 44% the prior year.
