The inability of Americans to pay for health care has reached unprecedented levels, according to a new nationwide survey released by the West Health Institute in partnership with Gallup. The West Health-Gallup Healthcare Indices Survey, conducted between November 18 and December 27, 2024, reveals that over one-third of U.S. adults — approximately 91 million people — say they would be unable to afford quality health care if they needed it today. 

This marks the highest level of unaffordability recorded since the survey began tracking the issue in 2021, reflecting a worsening trend in health care access and affordability across the country. 

The crisis is most acute among Black and Hispanic Americans, with 46% and 52%, respectively, reporting they cannot afford needed care. The disparity is also stark among income groups: nearly two-thirds (64%) of individuals earning less than $24,000 annually, and 57% of those earning between $24,000 and $48,000, say health care is financially out of reach — an 11- and 12-point spike from the previous year. 

In contrast, higher-income households have largely remained insulated from these financial pressures, underlining a deepening economic divide in the health care system.  Only 51% of Americans are now considered “cost-secure,” meaning they have not recently faced difficulty accessing or affording health services or prescription medication. This is the lowest level of cost-security recorded since 2021. 

“Health care affordability and access continue to erode nationally, and this issue is especially acute among Black, Hispanic, and lower-income adults,” said Dan Witters, senior researcher at Gallup. “Among these groups, this is the widest gap in access to care we have recorded thus far, with many Americans experiencing increased hardship year over year.” 

The findings raise fresh concerns about systemic inequities in the U.S. health care system and underscore the urgent need for policy action to address financial barriers to care, particularly for vulnerable populations.