Healthcare Costs Rank as Top Concern for 78% of Americans, Survey Finds

Healthcare affordability remains the leading healthcare concern among Americans, according to a new Commonwealth Fund survey conducted in partnership with research firm SSRS.

The survey, What Americans Want Fixed in Health Care and Who They Think Should Do It, draws on interviews with more than 25,000 U.S. adults. The findings show widespread concern about insurance premiums and out-of-pocket healthcare expenses across different ages, income levels, and political backgrounds.

Nearly 8 in 10 Americans, or 78%, identified financial issues as their primary healthcare concern.

Healthcare Costs Outpace Other Concerns

Insurance premiums and out-of-pocket spending ranked considerably higher than other challenges identified by respondents.

According to the survey, 15% cited operational issues such as prior authorization delays as a primary concern, while 7% pointed to difficulty finding a doctor.

Premiums were a leading concern among people who pay them through employer-sponsored coverage, individual or marketplace plans, and Medicare. Uninsured respondents also identified premiums as a significant concern.

The Commonwealth Fund reported particularly great concern about premiums and out-of-pocket expenses among people with employer, individual, or marketplace coverage, as well as those without insurance.

Cost Concerns Cross Political Lines

Healthcare affordability also emerged as a concern across political affiliations.

Republicans, Democrats, and Independents reported similar financial pressures involving monthly insurance premiums and high deductibles. However, respondents differed over who should take primary responsibility for addressing those costs.

For insurance premiums, 51% of respondents said the federal government was best positioned to address the problem, compared with 28% who selected insurance companies.

When asked about out-of-pocket expenses, 41% pointed to the federal government and 36% identified insurance companies.

Political differences became more apparent when respondents considered potential solutions. Among Democrats, 65% identified the federal government as best positioned to address premium costs, compared with 36% of Republicans. Still, approximately one-third of Republican respondents saw a role for federal intervention.

Employers Respond to Rising Healthcare Expenses

The Commonwealth Fund also examined how increasing healthcare expenses are affecting employer-sponsored coverage.

According to the analysis, employers facing rising medical costs may respond by shifting more expenses to workers through higher cost sharing, reduced benefits, stricter utilization management, and narrower provider networks.

The report also links affordability pressures in the Affordable Care Act marketplace to changes involving enhanced premium tax credits, marketplace rules, and out-of-pocket costs.

According to the Commonwealth Fund’s analysis, higher premiums can discourage healthier consumers from maintaining coverage, potentially leaving a smaller insurance pool with greater healthcare needs and higher costs.

Medical Debt Remains Part of Affordability Debate

The broader affordability discussion also intersects with ongoing policy debates over medical debt and credit reporting.

Federal and state policymakers have pursued different approaches to limiting the financial consequences of unpaid medical bills. These policies have also generated debate among healthcare providers, consumer advocates, credit reporting stakeholders, and the accounts receivable management industry over their potential effects on healthcare and credit access.

At the state level, Massachusetts has considered rules that would prohibit healthcare providers and third-party debt collectors from reporting medical debt to credit bureaus.

Massachusetts Gov. Maura Healey also identified a medical debt credit reporting ban as an initiative during her 2026 State of the Commonwealth Address.

States Consider Different Medical Debt Policies

Medical debt legislation and litigation are also continuing elsewhere.

In Michigan, lawmakers considered bipartisan legislation addressing medical debt collection and credit reporting, along with proposals involving uniform hospital charity-care requirements.

Meanwhile, litigation involving Colorado House Bill 23-1126 continues. ACA International has challenged restrictions involving medical debt information, arguing that they conflict with the federal Fair Credit Reporting Act’s preemption provisions and raise First Amendment concerns involving truthful commercial speech.

These developments illustrate how states are taking different approaches to medical debt while the broader debate over healthcare affordability continues.

Affordability Remains a Central Issue

The Commonwealth Fund’s survey demonstrates that healthcare costs remain a common concern even among Americans who differ on other healthcare policy questions.

While respondents vary over who should address the problem and what policies should be pursued, premiums and out-of-pocket expenses clearly rank ahead of other healthcare concerns measured by the survey.

As federal and state policymakers continue considering healthcare affordability and medical debt policies, the survey provides a snapshot of where consumers place their priorities: for a large majority, the cost of obtaining and using healthcare remains the central concern.