Forty-six percent of U.S. adults — regardless of insurance type — reported struggling to afford healthcare last year, according to a report released Wednesday by the Urban Institute, a nonprofit research think tank.
The report analyzed findings from a December 2025 survey of 10,000 working-age adults across the nation. Funded by the Robert Wood Johnson Foundation, the research comes at a time of U.S. cost-of-living concerns and economic woes.
Uninsured adults were most likely — 60% — to report at least one affordability problem.
Researchers defined affordability challenges as: trouble paying family medical bills in the past year, a family member not getting healthcare they needed due to costs, or the family having medical debt at the time of the survey.
Almost 40% of adults with private employer coverage, roughly 54% of those with Marketplace or plans, and 57% of adults with Medicaid reported having problems affording medical care.
More than a third — about 35% — of all surveyed adults said a family member had unmet healthcare needs because of costs.
The survey also found disparities in care affordability.
Adults with disabilities, for example, were more likely to have trouble affording healthcare for their families at almost 69% of those surveyed, compared with 40% of adults without disabilities. And the majority of Black and Hispanic adults reported struggling to afford care, compared with about 42% of white adults and 28% of Asian adults.
Health conditions also coincided with affordability troubles: More than 7 in 10 people who suffered strokes reported problems affording care for their families, followed by 70% of those with COPD, chronic bronchitis or emphysema, and about 64% of those with cancer and heart disease.
Half of adults living in the South — a region home to several states that haven’t expanded Medicaid eligibility — and those in rural areas of the country also reported affordability challenges, in contrast with roughly 45% of adults in urban areas.
Survey results also showed about 1 in 5 adults with private health insurance coverage reported large increases in insurance premiums — but adults with individual Marketplace plans were nearly twice as likely to report large premium increases as those with employer coverage.
According to health policy research organization KFF, the average Marketplace deductible surged by about $1,000 per person this year, as more enrollees shift to higher-deductible plans after enhanced subsidies expired.
Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Maryland Matters, and is supported by grants and a coalition of donors as a 501c(3) public charity.