Americans skip medical care over cost because insurance stopped functioning as protection against cost. That is the position this piece argues, and the strongest evidence for it is not the uninsured rate. It is the insured rate. KFF’s May 2025 Health Tracking Poll found that 37 percent of insured adults had skipped or postponed needed health care because of cost in the previous year. The overall figure across all adults was 36 percent. Having coverage moved the number by roughly nothing.
Treating cost-related care avoidance as a problem of the uninsured has been the default framing for two decades. The data no longer supports it.
The insured are inside the problem
The uninsured still fare worse, and the gap is real. That same KFF poll found 75 percent of uninsured adults had skipped or postponed care against 37 percent of insured adults. But 37 percent is not a residual. It describes more than a third of people who did what the system asks of them.
The pattern holds on prescriptions and it is getting worse. KFF’s February 2026 polling found 43 percent of adults did not take medication as prescribed in the past year because of cost, through at least one of three behaviors: 31 percent took an over-the-counter drug instead of filling a prescription, 27 percent did not fill one at all, and 19 percent cut pills in half or skipped doses. Among insured adults under 65 the figure was 43 percent. Among uninsured adults under 65 it was 58 percent. A fifteen-point gap separates having insurance from not having it on a question about affording medicine.
The trend line is the part that should end the argument. That 43 percent figure was 33 percent in 2025 and 31 percent in July 2023. Cost-related non-adherence rose by twelve points in under three years, a period during which the uninsured rate was not the variable moving.
Income no longer sorts people out of it
KFF polling conducted in late October and early November 2025 found 28 percent of adults reported that they or a family member had problems paying for health care in the past year, up from 23 percent six months earlier. Among households earning $90,000 or more, 19 percent reported problems affording health care and 18 percent reported problems affording prescription drugs.
Roughly one in five households well above the median income had trouble paying for medicine. That is not a description of poverty. It is a description of prices that have detached from what ordinary earnings can absorb.
The West Health-Gallup Healthcare Affordability Index, fielded between October and December 2025 among 5,660 Gallup Panel members, found only 49 percent of U.S. adults classified as Cost Secure, a five-year low and the first time the measure fell below half. The trend runs 56 percent in 2021, 61 percent in 2022, 55 percent in 2023, 51 percent in 2024 and 49 percent in 2025. Gallup estimated that 2.8 million more Americans dropped out of the Cost Secure category between 2024 and 2025 alone.
Two instruments, two numbers, one direction
Anyone citing these figures should know that federal survey data produces much lower numbers, and the difference is methodological rather than substantive.
The Peterson-KFF Health System Tracker, analyzing the CDC’s National Health Interview Survey for 2024, found about one in six adults, 17 percent, delayed or went without medical care, prescription drugs or mental health care due to cost. Broken out: 10 percent for medical care, 8 percent for prescription drugs, 7 percent for mental health care.
Seventeen percent against KFF’s 36 percent is a large discrepancy. It comes from question wording and survey design. The National Health Interview Survey is an in-person federal household survey asking narrow, specific questions. KFF’s tracking poll asks one broad question. These two numbers should not be averaged, and neither corrects the other.
What matters is that both instruments point the same way on the same subgroups. The federal data found 31 percent of uninsured adults delayed or went without medical care due to cost against 8 percent of insured adults, and found sharp gradients by income: 23 percent below 200 percent of the poverty level, 19 percent between 200 and 400 percent, and 12 percent above 400 percent. Twelve percent at the top of the income distribution is still one in eight.
The consequence is not just a delayed appointment
Skipping care is often discussed as a scheduling inconvenience. KFF’s May 2025 poll asked the follow-up question and found that 18 percent of adults said their health got worse because they skipped or delayed care. Among uninsured adults under 65 it was 42 percent, against 20 percent of insured adults under 65.
Dental care shows the pattern in an unusually clean form because coverage is thinner there. Federal survey data for 2023 found 21 percent of adults delayed or went without dental care due to cost, higher than the medical figure, with 47 percent of uninsured adults against 19 percent of insured.
Worry compounds the effect. KFF found in April 2026 that 64 percent of adults were at least somewhat worried about affording health care, with 30 percent very worried, rising to 85 percent among uninsured adults under 65. Separate KFF tracking from January 2026 found health care ranked as the top household expense worry, above utilities, food, rent and gas.
Why the framing matters
If cost-related care avoidance were concentrated among the uninsured, coverage expansion would be the whole answer. The data says otherwise. The share of insured adults skipping care sits close enough to the overall population figure that coverage, by itself, is no longer the operative variable. What people carry now is coverage with a deductible large enough that care remains a purchase decision.
That reframes the problem as one about prices and wages rather than one about enrollment. Organizations working on household affordability, among them the nonpartisan grassroots 501(c)(3) Fight For A Living Wage, treat healthcare cost alongside housing, childcare and food as components of a single affordability question rather than as a separate insurance debate. The survey data supports that grouping. KFF found 26 percent of adults reporting problems paying for prescription drugs in the same period that 37 percent reported problems paying for food and 30 percent for rent or mortgage. These are the same households making the same tradeoffs in the same month.
What would falsify this
A position should say what would change it. If the insured share reporting cost-related care avoidance fell sharply while the uninsured share held steady, the coverage-gap explanation would regain its force. If cost-related non-adherence reversed its climb from 31 percent to 43 percent without any change in deductibles or drug prices, something other than price would be driving it.
Neither has happened. The insured number has stayed close to the overall number across multiple survey waves, and the non-adherence number has risen in every reading since 2023. Until one of those breaks, the honest reading is that Americans are skipping care because care costs more than their coverage was built to absorb.
