Healthcare Affordability Is Now Everyone's Problem — Not Just the Uninsured
When most people think about the healthcare affordability crisis in the United States, they picture someone without insurance — a worker between jobs, a freelancer, or a low-income individual who simply cannot access the system. But a major new study is challenging that assumption in a powerful way. According to research funded by the Robert Wood Johnson Foundation and conducted by the Urban Institute, nearly half of all working-age Americans struggled to afford healthcare in 2025, and a significant portion of them had health insurance coverage at the time.
This finding should send a wake-up call to employers, policymakers, and healthcare advocates alike. Insurance is no longer a reliable shield against financial hardship when it comes to medical care. As premiums rise and out-of-pocket costs climb, millions of Americans — insured and uninsured — are being priced out of the care they need.
The Numbers Behind the Crisis
The data from the Urban Institute study paints a stark picture of just how widespread healthcare affordability challenges have become. More than one-third of working-age Americans reported that someone in their household had experienced unmet healthcare needs because the cost of care was simply too high. These are not edge cases or statistical outliers — these are everyday families making painful tradeoffs between medical treatment and other basic necessities.
Among the uninsured, 60% reported affordability challenges — a figure that is, perhaps, unsurprising. But the numbers among insured populations are what truly distinguish this study from prior research:
- 4 in 10 adults who receive health insurance through an employer reported affordability challenges in accessing care.
- 54% of people who purchase insurance independently on the marketplace said they struggled to afford the care they needed.
- 57% of those enrolled in Medicaid — a program specifically designed for lower-income individuals — still reported difficulty affording care.
These statistics underscore a critical truth: having a health insurance card in your wallet does not guarantee that you can actually afford to use it. Deductibles, copayments, coinsurance, and the rising costs of prescription drugs all add up to create significant financial barriers even for covered individuals.
Who Is Hit the Hardest?
While the affordability crisis touches Americans across all demographics, the research reveals that certain populations face disproportionately severe challenges. Understanding who is most vulnerable is essential for crafting meaningful policy solutions.
Working-age adults with disabilities face some of the greatest burdens, with 69% reporting healthcare affordability challenges. This is particularly troubling because individuals with disabilities often require more frequent medical care, specialist visits, and ongoing treatment — meaning the financial exposure is not occasional but chronic and compounding.
Similarly, 65% of individuals in fair or poor health reported difficulties affording care. People with chronic conditions face an especially cruel paradox: the sicker you are, the more care you need, and the harder it becomes to pay for that care. The study found that more than 6 in 10 individuals diagnosed with serious conditions — including stroke, chronic obstructive pulmonary disease (COPD), cancer, heart disease, and diabetes — reported affordability challenges.
Racial and geographic disparities compound the problem further. More than half of Black and Hispanic adults reported difficulty affording healthcare. Residents of Southern states and people living in rural areas also reported elevated rates of affordability challenges, reflecting well-documented gaps in healthcare infrastructure and coverage access in those regions.
Rising Premiums and Out-of-Pocket Costs: A Double Burden
Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation, put it plainly: "Affordability of healthcare is everyone's concern, not just people who are uninsured. In addition to rising premiums, higher out-of-pocket costs make many people less secure and potentially less healthy as they avoid needed care."
This dual pressure — higher premiums on one side and escalating out-of-pocket costs on the other — creates a trap that is difficult for middle-income families to escape. A family might dutifully pay their monthly premium only to discover that their deductible is so high that they still cannot afford to see a specialist or fill a critical prescription. The result is predictable: people delay or forgo care, and health conditions worsen as a result.
This avoidance of care has long-term consequences not just for individuals and families, but for the broader healthcare system and economy. Untreated conditions become more serious and more expensive to treat. Productivity suffers. Emergency room visits spike. The downstream costs of healthcare avoidance far exceed the short-term savings that families desperate to cut expenses are hoping to achieve.
What This Means for Employers
For employers who sponsor health insurance for their workers, these findings carry important implications. Offering coverage is no longer enough. If 4 in 10 employees with employer-sponsored insurance are still struggling to afford care, employers need to take a harder look at plan design. High-deductible health plans have become ubiquitous, but when employees cannot afford to meet their deductibles, the "insurance" they carry offers little practical protection.
Employers have both a business interest and a moral responsibility to ensure that their benefits packages are genuinely usable. Employee wellbeing, productivity, and retention are all tied to whether workers feel secure in their ability to access healthcare without financial devastation. Benefits leaders should be examining deductible levels, out-of-pocket maximums, and the availability of supplemental resources like health savings accounts or employee assistance programs that can help bridge affordability gaps.
A Call for Broader Policy Action
Beyond the employer level, the findings from this Urban Institute research make a compelling case for systemic policy intervention. When a majority of Medicaid enrollees still struggle to afford care, and when nearly half of all working-age adults — insured or not — face financial barriers to treatment, it is clear that insurance coverage alone is not a sufficient solution to the healthcare affordability crisis.
Policymakers at the federal and state level must grapple with the structural factors driving costs upward: hospital consolidation, pharmaceutical pricing, administrative overhead, and the growing prevalence of high-deductible plan designs. Addressing these root causes will require sustained political will and cross-sector collaboration.
In the meantime, the human cost of inaction is mounting. Families are skipping medications, postponing surgeries, and living with untreated conditions because the system — even with insurance — has become too expensive to navigate. Healthcare affordability is no longer a fringe issue or a problem only for the margins of society. It is a mainstream crisis affecting tens of millions of American families, and it demands an urgent, comprehensive response.