Americans’ Challenges with Health Care Costs – KFF

Report on U.S. Health Care Costs and Public Experience: Emphasizing Sustainable Development Goals (SDGs)

Editorial Note: This report incorporates updated data from KFF polling as of December 11, 2025, originally published on December 14, 2021.

Introduction

Health care costs remain a significant burden for U.S. families, influencing decisions about insurance coverage and care-seeking behavior. These financial challenges align with the United Nations Sustainable Development Goal 3 (Good Health and Well-being), which aims to ensure healthy lives and promote well-being for all at all ages. This report summarizes recent KFF polling data on public experiences with health care costs, highlighting key findings relevant to SDG 3 and SDG 10 (Reduced Inequalities).

Main Findings

1. Affordability Challenges: Nearly half of U.S. adults find it difficult to afford health care costs, with approximately 30% reporting problems paying for care in the past year. Hispanic adults, young adults, and the uninsured are disproportionately affected.
2. Delayed or Forgone Care: About 36% of adults have skipped or postponed needed health care due to cost, with 75% of uninsured adults under 65 reporting such behavior.
3. Prescription Drug Costs: One in five adults have not filled prescriptions due to cost, and one-third have taken cost-saving measures such as using over-the-counter alternatives or skipping doses.
4. Health Care Debt: Approximately 41% of adults carry medical or dental debt, with higher prevalence among Black and Hispanic adults, women, parents, low-income individuals, and the uninsured.
5. Insurance Coverage Limitations: Even insured adults face financial burdens, with nearly 38% worried about affording monthly premiums and many rating their insurance coverage as inadequate regarding premiums and out-of-pocket costs.
6. Financial Worries: Around 60% of adults express worry about affording health care services and unexpected medical bills.

Difficulty Affording Medical Costs

Under SDG 3 and SDG 10, equitable access to affordable health care is critical. Data indicate:

• 44% of U.S. adults find it difficult to afford health care costs.
• Uninsured adults under 65 report an 82% difficulty rate versus 42% among insured adults.
• Hispanic (55%) and Black adults (49%) report higher difficulty compared to White adults (39%).
• Lower-income households (

Approximately 28% of adults or their household members had problems paying for care in the past year, with Hispanic adults (41%) and young adults aged 18-29 (40%) disproportionately affected. Among uninsured adults under 65, 59% reported payment problems, double the rate of insured adults (30%).

Impact of Cost on Care Seeking

• 36% of adults skipped or postponed needed care due to cost.
• Women (38%) are more likely than men (32%) to delay care.
• Older adults (65+) are less likely to delay care, likely due to Medicare coverage.
• 75% of uninsured adults under 65 delayed care due to cost.
• 37% of insured adults also report delaying care due to cost.

Health consequences include 18% of adults reporting worsened health due to skipped or postponed care. Uninsured adults under 65 are twice as likely as insured peers to report health deterioration (42% vs. 20%).

Prescription Drug Costs

Aligned with SDG 3, access to essential medicines is vital. Findings include:

• 23% of adults used over-the-counter drugs instead of prescriptions due to cost.
• 21% did not fill prescriptions because of cost.
• 15% cut pills in half or skipped doses to save money.
• 33% of adults took at least one cost-saving measure, with higher rates among women (39%), Hispanic adults (46%), and lower-income households (41%).
• Adults with chronic conditions are twice as likely to delay or forgo prescriptions due to cost (18% vs. 9%).

Health Insurance Cost Ratings

Health insurance is a key factor in financial protection (SDG 3 and SDG 10), yet many insured adults face affordability challenges:

• 61% rate their insurance positively for prescription out-of-pocket costs.
• 53% rate positively for out-of-pocket costs to see a doctor.
• 54% rate positively for monthly premiums.
• At least 30% rate insurance as “fair” or “poor” on these metrics.
• Employer-sponsored and Marketplace insurance holders report higher dissatisfaction compared to Medicare and Medicaid enrollees.
• Medicaid enrollees report fewer affordability issues due to nominal copays and lack of premiums.

Health Care Debt

Health care debt presents a significant barrier to achieving SDG 3 and SDG 10 goals:

• 41% of adults have medical or dental debt.
• 24% have past due or unpaid bills.
• 21% are paying bills over time directly to providers.
• 17% owe debt to banks, collection agencies, or other lenders.
• 17% carry credit card debt for medical bills.
• 10% owe family or friends money for medical expenses.
• Debt is more prevalent among lower-income adults, uninsured individuals, Black and Hispanic adults, women, and parents.

Vulnerabilities and Financial Worries Regarding Health Care Costs

Financial insecurity related to health care aligns with SDG 1 (No Poverty) and SDG 3:

• 62% of adults worry about affording health care services.
• 61% worry about unexpected medical bills.
• These worries exceed concerns about housing (51%), transportation (50%), utilities (49%), and food (48%).
• 82% of uninsured adults under 65 worry about affording health care services; 80% worry about unexpected bills.
• 38% of insured adults under 65 worry about affording monthly premiums.
• Approximately 50% of adults could not pay a $500 unexpected medical bill in full, risking debt accumulation.
• Women, lower-income individuals, Black and Hispanic adults are more vulnerable to financial hardship from medical bills.

Concerns Among Older Adults

• 57% of adults 65+ are anxious about affording nursing home or assisted living care.
• 50% worry about affording paid nursing or aide support services.
• Among adults aged 50-64, over 70% express anxiety about affording residential and paid care services.

Conclusion

The data underscore the critical need to address health care affordability and access in the United States, directly supporting the achievement of SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Policies aimed at reducing health care costs, expanding insurance coverage, and alleviating medical debt are essential to improve health outcomes and financial security for vulnerable populations.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article focuses on health care affordability, access to needed health services, and the burden of health care costs on U.S. families.
   • Issues such as skipping or postponing care, prescription drug affordability, and health care debt directly relate to ensuring healthy lives and promoting well-being.
2. SDG 1: No Poverty
   • Financial burdens from health care costs and medical debt contribute to economic hardship and poverty risks.
   • The article highlights disproportionate impacts on low-income households and vulnerable populations.
3. SDG 10: Reduced Inequalities
   • Disparities in health care affordability and debt among Hispanic, Black adults, uninsured, and low-income groups are emphasized.
   • The article addresses inequalities in access to affordable health care and financial protection.
4. SDG 8: Decent Work and Economic Growth
   • Health insurance coverage through employer-sponsored insurance and its affordability are discussed, linking to decent work and social protection.

2. Specific Targets Under Those SDGs Identified

1. SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services and medicines.
   • Target 3.c: Substantially increase health financing and recruitment, development, training, and retention of the health workforce.
2. SDG 1: No Poverty
   • Target 1.2: Reduce at least by half the proportion of men, women, and children living in poverty in all its dimensions according to national definitions.
   • Target 1.3: Implement nationally appropriate social protection systems and measures for all.
3. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or economic or other status.
4. SDG 8: Decent Work and Economic Growth
   • Target 8.8: Protect labor rights and promote safe and secure working environments for all workers.

3. Indicators Mentioned or Implied to Measure Progress

1. Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income (measuring financial protection in health).

• Implied by data on difficulty affording health care costs, skipping care due to cost, and health care debt.

• Implied by reports of adults skipping or postponing needed health care and prescription drug non-adherence due to cost.

• Implied by the financial burden and debt related to health care costs affecting low-income groups.

• Implied by disparities in health care affordability and debt among racial/ethnic and income groups.

• Indirectly related through discussion of employer-sponsored insurance and health coverage affordability.

4. Table of SDGs, Targets, and Indicators

Source: kff.org