Less than half of Americans could afford medical expenses and access to quality care last year, according to a new Gallup poll, highlighting mounting financial strain even among many higher-income households.

The share of “cost secure” Americans — those who could afford access to quality care and pay for doctors’ visits and prescriptions — fell to 49% last year, down from a peak of 61% in 2022 and marking the lowest level since Gallup began tracking the metric in 2021.

The decline in affordability is coupled with rising concerns among Americans about their ability to cover healthcare costs. Fifty-one percent of those polled by Gallup said they are concerned about paying for medical services in the next year, while 42% worry about affording prescription drugs.

The difficulty spans income levels. About one-third of households earning between $120,000 and $179,999 a year and one-fifth of those making at least $180,000 said they either lacked quality coverage or struggled to afford expenses such as prescription drugs, Gallup found.

Affordability is also a challenge across generations. Every age group in Gallup’s data, aside from those aged 50 to 65, shows a decline in the share of people who can afford healthcare from 2023 to 2025. Adults aged 18 to 29 are the most vulnerable, with only about a third considered cost-secure.

The data may only capture some of the strain Americans are currently feeling, as the study was conducted before the expiration of Affordable Care Act (ACA) tax subsidies in early 2026 caused premiums to spike — prompting some Americans to forgo insurance. 

Data from January shows ACA enrollment dipped by more than 1 million from 2025. KFF, a nonprofit provider of health policy news and research, estimates that nearly 5 million fewer people will enroll in ACA plans this year. 

In January, the Trump administration announced “The Great Healthcare Plan,” which the White House said would lower health insurance premiums and deliver money directly to Americans to cover healthcare costs. A month later, the administration launched TrumpRx, a site where Americans can get drugs at discounted prices.

Gallup based the findings on web and mail surveys of 5,660 U.S. adults conducted between October and December.