Twannetta Weaver felt like she made the responsible choice when she enrolled in a high-deductible health insurance plan through her employer, an option that avoided high premiums and allowed her to save for retirement.

Then, in 2025, she slipped a disk in her back, requiring medication and physical therapy. Suddenly, the medical bills were so overwhelming that Weaver, an adult learner working toward a leadership degree on the side, had to delay graduation by a year.

“I had to start calculating, am I going to be able to afford to pay my tuition, as well as my books, as well as my living expenses, and continue to care for my family?” the 43-year-old in Sanford, Florida, said in an interview. “It makes you feel powerless as a consumer.”

Weaver’s experience is familiar to a growing number of Americans, according to new data from the West Health-Gallup Affordability Index, which shows only about half of U.S. adults could afford their healthcare and had access to quality care last year. Concerns about affording healthcare in the year ahead were at a record high since tracking began in 2021, signaling that many were feeling anxious about rising healthcare costs as 2025 ended.

The new findings published Thursday draw on a survey conducted from October to December 2025 — before major recent changes to health policy, like Congress’ Medicaid cuts or its decision not to extend Affordable Care Act subsidies, took effect. It demonstrates how the country’s fraught healthcare system is increasingly straining Americans at a time when inflation is driving high costs and affordability concerns are top of mind as midterm elections approach.

Americans are worried they won’t be able to pay for care

The index used the responses from multiple questions to place Americans into three categories depending on their access to quality care and ability to pay for care and medicine. In the new data, 49% of U.S. adults were considered “cost secure,” meaning that they had access both to high-quality, affordable care and they had recently been able to afford the care and medicine they needed. In 2021, when the measurement began, 56% of U.S. adults were “cost secure.” That rose to 61% in 2022 but has been falling ever since.

In the survey, about three-quarters of U.S. adults said healthcare costs were a “major” or “minor” financial burden for them and their family. Only about 3 in 10 said they’re not a burden.

Meanwhile, about half of respondents were “extremely concerned” or “concerned” that their household would be unable to pay for needed healthcare services in 2026, up from 42% who said that in 2022.

Inger Perez, 59, from Encino, Texas, is one of those worried Americans. She has a family history of diabetes, high blood pressure and cancer. She said she did blood work recently, and while she wants to know the results, she’s bracing herself for what they could show.

“I literally was crying last night because I’m nervous about what I’m going to find out and how much care that is and how much money that is,” she said in an interview. “I’m terrified that I’ll start a plan of treatment but won’t be able to afford to keep up with it.”

More than half of survey respondents said the cost of healthcare contributes “a lot” or “some” to stress to their daily lives. That’s compared to about 3 in 10 who said these costs contribute “very little stress” and about 2 in 10 who said they contribute “no stress at all.”

Perez said she is also frustrated by the quality of the care she receives, in part because she lives in a rural area about an hour from a doctor’s office. To fit her budget, she had to choose a lower-cost Affordable Care Act marketplace plan with a limited network of covered providers, creating another obstacle to finding good care.

Healthcare affordability is declining across demographics

Younger adults, older adults and women were among several groups of Americans that saw drops in healthcare affordability and access in 2025, according to the findings.

Among Americans under 30, only about one-third were categorized as “cost secure,” down from 46% in 2021. Women were already less likely to be “cost secure” than men, but the gap widened last year. About 57% of men were “cost secure” in the 2025 survey — down from a high of 67% in 2022 — compared to 42% of women.

Older Americans, most of whom are covered by the government’s Medicare health insurance program, are generally more likely to be “cost secure.” However, this group saw meaningful decreases as well, falling from 73% in 2021 to 61% in 2025.

Patients make sacrifices to pay the bills

Several survey respondents who talked to The Associated Press discussed things they have had to give up to pay their health bills.

About 2 in 10 U.S. adults in the 2025 poll said there had been a time in the prior three months when they or a member of their household was unable to pay for medicine or drugs that a doctor had prescribed because of costs. About 3 in 10 said they or someone in their household did not seek treatment for a health problem because of the expense.

One dad in Arizona, 55-year-old Xavier Chapa, said his 50-year-old wife has been fighting her insurance company over a preventive colonoscopy that her doctor had recommended.

He said the company verbally assured her it would be covered, but didn’t honor that after the procedure was completed.

The looming $3,000 bill means they’ve had to cut back their 8-year-old son’s summer camp schedule from full-day to half-day programs, along with trimming their budget elsewhere.

“It’s a lot to deal with,” said Chapa, who moved back to the U.S. from Europe three years ago. “What point does it serve if you’re living in this country and having to pay such a high price and you can’t get some of the basic things?”

Swenson reported from New York.

The West Health-Gallup Center poll of 5,660 adults was conducted Oct. 27-Dec. 22, 2025 using a sample drawn from Gallup’s probability-based Gallup Panel. The margin of sampling error for adults overall is plus or minus 2.1 percentage points.