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In U.S., An Estimated 46 Million Cannot Afford Needed Care

In U.S., An Estimated 46 Million Cannot Afford Needed Care

Story Highlights

  • 35% of low-income earners were unable to pay for care in prior 12 months
  • One in eight (12%) have cut back on spending on food to pay for care
  • Broad support exists for capping out-of-pocket costs in Medicare

Editor's Note: The research below was conducted in partnership between West Health and Gallup.

WASHINGTON, D.C. -- Nearly one-in-five U.S. adults -- 18%, about 46 million people -- report that if they needed access to quality healthcare today, they would be unable to pay for it. These results are based on a new study conducted by West Health and Gallup.

Ability to Afford Quality Care, by Race/Ethnicity and Age
If you needed access to quality healthcare today, would you be able to afford it?
  Not able to afford quality care today
U.S. total 18
Black adults 29
Hispanic adults 21
White adults 16
Non-White adults 18-49 27
Non-White adults 50-64 26
Non-White adults 65+ 16
White adults 18-49 20
White adults 50-64 15
White adults 65+ 8
West Health-Gallup Healthcare Study; Feb. 15-21, 2021 (n=3,753)
Gallup Panel

This current measure of healthcare unaffordability runs considerably higher among Black adults (29%) and somewhat higher for Hispanic adults (21%) than for White adults (16%). And while unaffordability of care is lower for people 65 and older than for their younger counterparts, White older adults are half as likely to report such a condition as are non-White older people (8% and 16%, respectively).

This survey was conducted by web from Feb. 15-21, 2021, with 3,753 adults, ages 18+, living in all 50 U.S. states and the District of Columbia via the Gallup Panel, a probability-based panel of about 120,000 adults nationwide.

Needed Care Was Skipped by 18% of Households in Prior 12 Months

While 18% of survey respondents reported that that they would be unable to pay for quality care if they needed it today, the same percentage also reported that someone in their household skipped care they needed for cost reasons in the prior 12 months. That time period covers roughly the first year of the COVID-19 pandemic.

The chances of any given household suffering from this form of healthcare insecurity are inversely related to annual household income, with 35% of respondents from low-income households -- those earning under $24,000 per year -- reporting forgoing care in the prior 12 months. That is five times the rate reported by those from high-income households (7%), defined as earning at least $180,000.

U.S. Healthcare Insecurity, by Household Annual Income
Has there been a time in the last 12 months when you or a member of your household had a health problem, but you did not seek treatment due to the cost of care?
  Could not afford care in prior 12 months
U.S. total 18
Under $24,000 35
$24,000-<$48,000 27
$48,000-<$90,000 19
$90,000-<$120,000 11
$120,000-<$180,000 10
$180,000 or more 7
West Health-Gallup Healthcare Study, Feb. 15-21, 2021
Gallup Panel

Reduction in Household Spending Due to Cost of Care Spans All Income Groups

With nearly one in five U.S. adults forgoing some healthcare in the prior 12 months due to the cost, many Americans are cutting back on household spending to pay for the care that they currently are receiving. About one in eight adults, for example, say they cut back their spending on food (12%) and over-the-counter drugs (11%) to pay for healthcare or medicine. The proportion doing this rises to about 1/4 of those in households earning less than $24,000 annually. Additionally, 21% of those from low-income households have had to reduce spending on utilities due to the cost of care, underscoring the disproportionate sacrifices made by lower-income households in the COVID-era.

Over one-third (35%) of respondents, in turn, report that they have reduced spending on recreational or leisure activities in the previous 12 months in order to afford care, including 21% of those in households earning at least $180,000 per year.

Reductions in Household Spending Due to Cost of Healthcare, by Income
In the last 12 months, has your household reduced spending on any of the following to pay for the healthcare or medicine that you required? (% Yes)
  U.S. total <$24K $24K-<$48K $48K-<$90K $90K-<$120K $120K-<$180K $180K+
  % % % % % % %
Recreational or leisure activities 35 50 45 37 32 27 21
Clothing 26 43 32 29 19 20 13
Food 12 24 19 13 7 6 4
Over-the-counter drugs 11 25 15 11 7 6 3
Utilities 9 21 14 9 5 4 3
West Health-Gallup Healthcare Study, Feb. 15-21 2021 (n=3,753)
Gallup Panel

Majority Support Exists for Cost Containment and Broader Access Policies

As substantial percentages of U.S. adults have had to reduce spending on basic household goods to pay for healthcare, public support runs high for various proposed forms of government action meant to make healthcare more affordable.

For example, over 80% of Americans -- including over 70% of Republicans -- favor setting caps on out-of-pocket costs for both prescription drugs and general healthcare services for those who are insured by Medicare. And lowering the age of Medicare eligibility to 60 is supported by 65% of adults, including 60% of political independents and 42% of Republicans.

Other options are viewed quite differently by the major political party groups. While 60% of all Americans favor "making Medicare available to everyone," support ranges from 93% among Democrats to 19% among Republicans. Similarly, 59% favor "expanding and strengthening" the Affordable Care Act; but the 98% of support among Democrats contrasts with 15% among Republicans. Slight majorities of independents endorse both proposals.

Support for Proposed Government Healthcare Policy, by Political Identity
Do you favor or oppose the federal government enacting policy for each of the following? (% Favor)
  U.S. total Democrat Independent Republican
  % % % %
Setting caps on out-of-pocket costs for prescription drugs in Medicare 88 97 83 81
Setting caps on out-of-pocket costs for general healthcare services in Medicare 85 96 80 74
Lowering the age of Medicare eligibility to 60 65 86 60 42
Making Medicare available to everyone 60 93 54 19
Expanding and strengthening the Affordable Care Act 59 98 51 15
West Health-Gallup Healthcare Study, Feb. 15-21, 2021 (n=3,753)
Gallup Panel


As the U.S. enters its second year of the COVID-19 pandemic, economic recovery, though uneven, has also progressed with 379,000 jobs added in February, considerably exceeding projected forecasts for the month and totaling 17 million recovered jobs since April. The passage of the new $1.9 trillion COVID-19 relief bill, which was debated but not yet passed until after this survey, stands to provide additional relief to large numbers of households and businesses in need.

Despite these reasons for optimism, the cost of healthcare and its potential ramifications continues to serve as a burdensome part of day-to-day life for millions of Americans, illustrating the enduring nature of the issue as the U.S. slowly enters the closing stages of the pandemic. Over a 12-month period that roughly covers the first full year of the COVID-era, 18% of American households had to forgo some degree of needed healthcare because they were not able to afford it due to the cost. And, one year in, 18% of adults report that they would be unable to afford quality care if they needed it today. These realities can spill over into other health issues, such as delays in diagnoses of new cancer and associated treatments that are due to forgoing needed care.

The practical ramifications of widespread reductions in basic household spending to offset the cost of care are considerable and should not come with great surprise given the substantial number of Americans who suffer its effects. Dovetailing with these realities is majority support for a number of public policies currently being considered, underscoring a public that continues to remain open to government action designed to provide relief from healthcare expenses.

Learn more about how the Gallup Panel works.

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