Cost Leads Americans' Top-of-Mind Healthcare Concerns

Editor’s Note: This research was conducted in partnership with the West Health-Gallup Center on Healthcare in America, a joint initiative to report the voices and experiences of Americans within the healthcare system.

Americans’ already elevated perception that the cost of healthcare is the “most urgent health problem” facing the country rose further this year to 29%, up from 23% a year ago. The latest figure is the highest level recorded since 2004 and also one of the highest readings in the trend dating back to 1987. Cost now outpaces access to healthcare, at 17%, and obesity, at 8%, as what Americans consider to be the nation’s top health problem.

These findings are from the West Health-Gallup Health and Healthcare Survey, conducted Nov. 3-25. Cost and access have typically topped the list of health problems in the U.S. since 2000, although they were displaced during the pandemic in 2020 and 2021, as people were mainly concerned about COVID-19. But as that focus lessened, concerns about cost and access returned.

Today’s 29% of Americans mentioning healthcare costs exceeds the 16% to 27% range seen in the five years before the pandemic and is one percentage point shy of the record-high 30% measured in 1992. Twenty-nine percent also cited cost as the most urgent health problem in 2004.

While up from 2020, mentions of access to healthcare remain below the 22% recorded in the last pre-pandemic measure in 2018 and the record highs of 29% in 2007 and 2008.

After obesity, the specific medical issues most often cited as the nation’s top health problem are cancer and mental illness, both at 4%. Mentions of cancer are down sharply from the 10% seen before the pandemic. On the other hand, mentions of mental illness, which peaked at 7% as a concern in 2023, remain higher than the pre-pandemic rates that were mostly below 3%.

Record-Low 16% Satisfied With Cost of U.S. Healthcare

Low satisfaction with U.S. healthcare costs is another indication of the public’s sharpened concern about affordability. Satisfaction with U.S. healthcare costs is the lowest Gallup has recorded in annual trends since 2001, as 16% now say they are satisfied, compared with 19% a year ago and an all-time high of 30% in the first year of the pandemic.

Meanwhile, U.S. adults’ satisfaction with their own healthcare costs remains steady at 57%, similar to where it’s been since 2022. This too was elevated during the pandemic, but the current level is similar to the rate seen for most of the two decades leading up to 2020.

A similar picture is seen in the public’s ratings of healthcare coverage, with a strong majority rating their own healthcare coverage positively, while a reduced minority say the same of healthcare coverage nationally.

Currently, 65% of Americans say their own healthcare coverage is excellent or good, just slightly below the average of 68% since 2001. At the same time, 24% rate healthcare coverage nationally this positively, down from last year’s 28% and the average of 32% across the trend. Today’s positive rating of U.S. healthcare coverage is the lowest Gallup has recorded in two decades.

Record-High 23% Say U.S. Healthcare System ‘in State of Crisis’

Americans’ elevated concern about the nation’s healthcare costs combined with their lower evaluation of coverage may be contributing to a record-high 23% now saying the U.S. healthcare system is “in a state of crisis” and another 47% saying the system has “major problems.” Fewer U.S. adults, 26%, describe the problems as “minor,” and just 3% believe the healthcare system is free of problems.

The current findings are a continuation of the pattern seen since 1994, whereby in most years, pluralities or majorities of Americans have said the nation’s healthcare system has major problems. However, the 23% describing the system as being in crisis is the highest in Gallup’s trend to date, by two points over 2009 and 2013 readings. Compared with last year, more say the system is in crisis (up seven points) and fewer say it has major problems (down seven points).

Between 2001 and 2011, spanning both George W. Bush’s presidency and the start of Barack Obama’s, Democrats were the most likely to say the healthcare system had major problems or worse. However, since the passage of the Affordable Care Act in 2010, partisans’ views of the healthcare system have been more sensitive to the party in power. That is, Republicans and Democrats have generally offered better assessments of the healthcare system when the sitting president’s party has matched their own.

The 81% of Democrats who now say healthcare is in a state of crisis or has major problems is up 10 points since last year and is similar to the group’s 84% record high in 2018, during Donald Trump’s first term. Meanwhile, Republicans’ negative assessment of the healthcare system (64%) has dropped seven points since last year, when Joe Biden was in office. Throughout the trend, independents’ views have generally been similar to those of U.S. adults overall.

Nearly Two-Thirds Say Government Should Ensure All Have Coverage

When it comes to the public’s preference for government involvement in the healthcare system, 64% of U.S. adults believe it is the federal government’s responsibility to ensure that all Americans have healthcare coverage. This is the highest percentage since 2007 calling for such government intervention, although the reading has been consistently at the majority level over the past decade.

Similarly, from 2000 through 2008, majorities of Americans said it was the government’s responsibility to make sure all Americans had health coverage. However, during the Obama administration, as the ACA was drafted, passed into law and implemented, public support for government intervention in this realm was at or below 50%. The reading slipped to a low of 42% in 2013 during the troubled rollout of the ACA healthcare exchanges. The high point in belief that the government should ensure coverage for all was 69%, recorded in 2006.

Partisans’ views of the federal government’s responsibility to ensure healthcare for all Americans differ sharply, as they have throughout the trend. Currently, 90% of Democrats and 73% of independents, but just 26% of Republicans, think the government is responsible. This 64-point gap between Democrats and Republicans is among the largest in the 25-year trend, while the reading among independents is the highest for the group by two points.

Public Divided Over Private vs. Government-Run Healthcare System

At the same time that a majority of Americans see a government role in ensuring universal U.S. healthcare coverage, they are divided over whether the nation’s healthcare system should be based on private insurance or run by the government. Currently, 48% of U.S. adults prefer a private system, while 46% support a government-run system. This is the second straight year that U.S. adults are divided.

From 2010, when the measure was first tracked, through 2023, majorities of Americans favored private insurance, with just one exception: 2017, when they were evenly divided in preferences.

Democrats’ long-standing majority-level preference for a government-run system persists, as 67% now favor it. This compares with a relatively steady 18% of Republicans and a new high of 51% of independents.

Bottom Line

Americans’ concerns about the U.S. healthcare system persist, with the cost of healthcare as the nation’s top health problem at its highest level in more than two decades. This rise comes ahead of 2026 premium increases for ACA subscribers, absent any last-minute legislative remedy from Congress and the president. This heightened concern is reinforced by record-low satisfaction with the cost of U.S. healthcare and diminished ratings of the nation’s healthcare coverage overall, even as most Americans remain satisfied with their own coverage and personal healthcare costs.

These pressures on affordability and system performance are shaping broader public judgments about the health system. Seven in 10 Americans say the U.S. healthcare system has major problems or worse, including a record-high 23% who believe it is in a state of crisis. Partisan dynamics continue to influence perceptions of system quality.

Meanwhile, the highest percentage of Americans since 2007 say the government should ensure that all Americans have healthcare coverage. Approval of the Affordable Care Act has reached a new high, suggesting the law’s standing has strengthened as Americans weigh the trade-offs of the current system and concerns about affordability.

Despite rising support for government responsibility, Americans remain closely divided over whether the nation’s healthcare system should rely on private insurance or be run by the government. Together, these findings point to a complex healthcare policy environment — one in which Americans are looking for financial relief while being satisfied with their current coverage and are split along partisan lines over how much to rely on government-backed insurance solutions.

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