When Healthcare Becomes Too Expensive to Use

For millions of Americans, the decision to see a doctor is increasingly accompanied by another question: how much will it cost? Recent surveys show that healthcare affordability is influencing whether people seek treatment, fill prescriptions and follow through on medical recommendations, even when they have insurance.

KFF reported in April 2026 that 36% of U.S. adults said they had skipped or postponed needed healthcare during the previous 12 months because of cost. Nearly four in ten insured adults under 65 also reported cost-related barriers to care. The problem is substantially more severe among the uninsured, but insurance does not eliminate it.

That distinction is important. The U.S. healthcare affordability problem is no longer simply a question of whether someone has an insurance card. For many households, the more difficult question is whether the coverage they have makes treatment financially manageable.

Insurance does not remove the price problem

Employer-sponsored insurance remains the principal source of coverage for many working-age Americans. KFF estimates that employer plans cover 154 million people under 65.

Yet the financial obligations attached to that coverage can be substantial. In 2025, the average annual premium for employer-sponsored family coverage reached nearly $27,000. Workers contributed an average of $6,850 toward that premium, while deductibles and other forms of cost sharing added another layer of potential expense.

The structure of these plans matters because healthcare spending is often uneven. A worker might have relatively modest medical expenses for most of the year and then face thousands of dollars in costs after a diagnosis, hospitalization or major procedure.

KFF found that 88% of covered workers were enrolled in plans with a general annual deductible for single coverage in 2025. Among workers with such deductibles, the average was $1,886. More than one-third of covered workers faced a deductible of at least $2,000.

For a household with limited savings, these expenses can turn a medical appointment into a financial decision.

Delay can become its own economic cost

The immediate response to an expensive medical bill may be rational from a household's perspective: postpone the appointment, wait before filling a prescription or search for a cheaper alternative.

But healthcare does not always behave like an ordinary consumer purchase. Delaying a diagnostic test can mean discovering a condition later. Skipping medication can affect whether a chronic illness remains under control. Postponing treatment can potentially allow a problem to become more complicated.

KFF's 2026 analysis of federal National Health Interview Survey data found that 17% of adults in 2024 reported delaying or not getting healthcare because of cost, including medical or mental healthcare and prescription-drug rationing.

The consequences are not merely theoretical. In KFF's polling, nearly one in five adults who had skipped or postponed needed care because of cost said their health had worsened as a result. Among adults under 65, the share was considerably higher for those without insurance.

This creates an uncomfortable economic feedback loop: an attempt to avoid a smaller expense today can sometimes contribute to a larger medical need later.

The pressure reaches employers

For businesses, delayed care can create costs that do not appear directly on a medical claim.

Employees who postpone treatment may eventually require more complex care. Chronic conditions that are not adequately managed can affect attendance and productivity. Workers may also spend time dealing with medical problems that could have been addressed earlier.

At the same time, employers are already confronting rising healthcare expenses. The average deductible among workers with employer coverage has increased substantially over the past decade, while out-of-pocket spending has grown faster than wages and general inflation over a longer period.

That creates a difficult balance for companies. Increasing employee cost-sharing can help contain employer spending, but it can also make healthcare less accessible to workers. Absorbing more of the expense protects employees but increases the cost of providing compensation.

The result is that healthcare benefits increasingly form part of the broader labor-cost equation.

Prescription drugs reveal the problem clearly

Medication is another area where affordability can directly influence behavior.

KFF's April 2026 analysis found that 43% of adults reported taking some measure to reduce prescription costs during the previous year. These measures included not filling a prescription, taking an over-the-counter medicine instead, cutting pills or skipping doses.

Such behavior is especially consequential because prescription medicines are often intended to prevent a condition from becoming more serious. The economic value of treatment may therefore extend beyond the price of the medication itself.

But that value is difficult to capture at the household level. A patient paying $100 for a prescription sees an immediate expense. The potential financial benefit of avoiding a hospitalization months or years later is uncertain and may not feel relevant when today's budget is already tight.

Affordability is becoming a broader consumer issue

The latest West Health-Gallup Healthcare Affordability Index illustrates the scale of the problem from another perspective. Gallup reported in June 2026 that only 49% of U.S. adults were classified as "Cost Secure" in 2025, meaning they reported access to affordable quality care and the ability to pay for needed care and medicine. Forty-one percent were classified as "Cost Insecure" and another 10% as "Cost Desperate."

These categories point to a problem that cuts across the insurance system. People can be formally insured while still being financially vulnerable to healthcare expenses.

The distribution is uneven. Lower-income households, uninsured adults and people with greater healthcare needs tend to face more severe affordability barriers. But the presence of substantial deductibles and cost-sharing means middle-income insured households can also face difficult choices.

What could change the trajectory?

The outlook will depend on more than insurance premiums.

Changes in prescription-drug prices, provider prices, employer benefit design, insurance competition and household incomes could influence affordability. Greater use of preventive care or lower-cost treatment settings could also reduce some expenses, although such changes would not automatically solve the underlying pricing problem.

Employers face their own strategic choice. They can continue shifting some costs to workers, redesign networks and benefits, or invest more heavily in programs intended to help employees access appropriate care earlier. None offers a universal solution.

For policymakers, the challenge is broader still. Delayed care can redistribute costs through the healthcare system rather than eliminate them. A bill avoided today may become a more expensive medical episode tomorrow, while untreated illness can carry consequences for employers, families and public programs.

The central issue is therefore not simply that Americans are spending more on healthcare. It is that the price of care is increasingly influencing whether care is used at all.

That distinction matters for the economy. Healthcare is both a major household expense and an essential input into a productive workforce. When people begin treating medical care as something to postpone until it becomes unavoidable, affordability becomes more than a personal financial concern. It becomes a question about how efficiently the wider economy is able to maintain the health of the people who sustain it.