Escalating Financial Barriers to Healthcare Access

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Recent data indicate a significant increase in the proportion of U.S. adults facing severe financial barriers to accessing necessary healthcare and medicine, categorized as "Cost Desperate." Findings from the West Health-Gallup Healthcare Indices Study reveal that 11% of U.S. adults, representing approximately 29 million individuals, met this classification in late 2024, the highest level recorded since the index's inception in 2021. This trend is marked by rapidly widening disparities along racial, ethnic, and socioeconomic lines. Notably, the prevalence of cost desperation has increased substantially among Hispanic and Black populations and lower-income households while remaining stable among White adults and higher-income groups, exacerbating existing inequities in healthcare access and affordability.

Healthcare affordability and access remain critical public health issues in the United States. The report analyzes trends in healthcare cost barriers using data from the West Health-Gallup Healthcare Indices Study, conducted November 18-December 27, 2024, via web and mail surveys of a representative sample of 6,296 adults (aged 18+). The study employs the Healthcare Affordability Index, classifying individuals into three tiers based on their ability to access and afford quality care and medicine, comprising the following categories:

• Cost Secure: Possess access to quality, affordable care and can consistently afford necessary care and medicine.
• Cost Insecure: Lack of access to quality, affordable care or have recently been unable to afford either needed care or medicine.
• Cost Desperate: Lack of quality, affordable care and recent inability to afford both needed care and medicine.

The analysis focuses on the rise of the "Cost Desperate" category and associated demographic disparities between 2021 and 2024. Here are some interesting findings:

• Overall Trend: The percentage of U.S. adults classified as Cost Desperate increased from 8% in 2021 to 11% in 2024, reaching its highest point in the study period. This represents a three percentage point increase overall.
• Racial and Ethnic Disparities: Significant divergences emerged among racial and ethnic groups. The proportion of cost-desperate Hispanic adults surged by eight percentage points (from 10% in 2021 to 18% in 2024). Similarly, Black adults experienced a five percent increase (from 9% to 14%). In contrast, the rate among White adults remained unchanged (8% in both 2021 and 2024). These differential trends have substantially widened the racial and ethnic gap in healthcare affordability challenges.
• Socioeconomic Disparities: Income level is strongly correlated with cost desperation. The most pronounced increase occurred in households earning less than $24,000 annually, where the rate rose by 11 percentage points (from 14% to 25%).  
• Age-Related Trends: While cost desperation remains lowest among adults 65 and older (4% in 2024, up 1 point since 2021), increases were more pronounced among younger cohorts. Rates rose by 3 points for those aged 50-64 (11%) and 4 points for those under 50 (14%).
• Decline in Cost Security: Concurrently, the percentage of adults classified as Cost Secure reached its lowest level at 51%. This decline was disproportionately experienced by Hispanic adults (down 17 points to 34%) and Black adults (down 13 points to 41%), compared to stable rates for White adults (58%). Similarly, large declines in cost security were observed among lower-income households (down 14 points to 23% for <$24k earners; down 12 points to 30% for  24k−< 48k earners).
• Access Metric: The specific measure of being unable to access affordable, quality care when needed rose to 35% overall in 2024, a 4-point increase from 2023 and a new high since 2021. This difficulty intensified most sharply for lower-income households (<$48,000 annually), further widening the access gap compared to higher-income households.

The escalating percentage of Cost Desperate Americans, particularly among minority and low-income groups, signifies a worsening crisis in healthcare affordability. These trends have tangible consequences, including increased financial strain, medical debt accumulation (estimated $74 billion borrowed for healthcare in the past year), significant stress, and potential trade-offs with necessities. The widening disparities suggest that recent economic pressures and policy shifts may disproportionately affect vulnerable populations. Possible contributing factors include sustained consumer and medical inflation, pharmaceutical shortages, and changes in public insurance enrollment, such as Medicaid disenrollment following the expiration of continuous enrollment provisions and reductions in CHIP enrollment. So, what are the conclusions of this information? The period from 2021 to 2024 witnessed a notable rise in the inability of U.S. adults to afford necessary healthcare and medicine, reaching a peak of 11%. This trend is characterized by a significant and growing divergence based on race, ethnicity, and income, indicating deepening inequities in the U.S. healthcare system. Addressing these disparities requires attention to underlying economic factors and healthcare policies impacting access and affordability for the most vulnerable populations.

Source: West Health-Gallup Healthcare Indices Study, Nov. 18- Dec. 27, 2024 (n=6,296).
Note: Percentage point changes are calculated as (2024 % value)(2021 % value). Positive values indicate an increase in the percentage of adults classified as Cost-Desperate.