West Health-Gallup Index Shows Cost-Secure Share of U.S. Adults Falls to 49 Percent in 2025

The October-December 2025 survey of U.S. adults classified respondents by access to quality care and ability to pay, yielding 49 percent cost-secure, 75 percent reporting costs as a financial burden, and 50 percent concerned about 2026 payments. These figures predate Medicaid cuts and ACA subsidy expiration, capturing cumulative effects of high-deductible plans chosen to reduce premiums. Cases such as Twannetta Weaver's delayed graduation after a disk injury illustrate how out-of-pocket spikes disrupt household budgets.

High-deductible designs interact with wage stagnation and rising drug prices to widen gaps that daily coverage often treats as isolated premium or copay stories. Rural respondents like Inger Perez encounter narrow networks in lower-cost ACA plans, adding travel and delay costs rarely quantified in poll toplines. Parallel KFF tracking shows similar stress gradients by age and sex, confirming the index decline is not an artifact of sampling.

Observational repeated cross-sections cannot isolate causation from policy drift or inflation, yet they align with employer-plan data showing deductibles rising faster than median wages since 2018. Next steps require linked claims-utilization studies that follow the same cohort after 2026 subsidy changes to test whether reported concern predicts actual foregone care.