Healthcare is getting harder for Americans to afford, and state-level data shows where that pressure is most often turning into skipped care.
Just 49% of U.S. adults were “cost secure” in 2025, meaning they could afford needed care. That is a five-year low and down from a peak of 61% in 2022, according to the West Health-Gallup Center on Healthcare. A separate West Health-Gallup survey of 19,535 adults found 1 in 3 made at least one financial trade-off to pay for care in the past year. The most common were borrowing money and delaying or stretching prescriptions, each reported by 15% of respondents. Among uninsured adults, 62% made such a trade-off.
Health systems are seeing the effects. Finance leaders at Banner Health, Trinity Health and HCA Healthcare have said patients are putting off care in 2026. The enhanced ACA premium tax credits expired at the end of 2025, and more people than expected went from exchange coverage to having no insurance. Patients are “delaying care or waiting until health problems are critical and require emergency care,” said Daniel Isacksen Jr., executive vice president and CFO of Trinity Health.
Nationally, 12.8% of adults said they needed to see a physician in the past 12 months but could not because of cost, according to KFF’s analysis of the CDC’s 2025 Behavioral Risk Factor Surveillance System. The rate was higher among adults with a chronic condition (13.9%) than among those without one (10.8%). Texas had the highest share at 18.1%, and Hawaii had the lowest at 7.3%.
Here is how the states and the District of Columbia rank, from highest to lowest share. California, Mississippi and Nevada did not have enough 2025 data to be included.
1. Texas: 18.1%
2. Georgia: 16%
3. Oklahoma: 15.1%
4. Arkansas: 14.9%
5. Alabama: 14.6%
5. Louisiana: 14.6%
7. Colorado: 13.9%
8. Florida: 13.7%
9. Arizona: 13.6%
10. New Jersey: 13.4%
11. Tennessee: 13.3%
12. Wyoming: 13.2%
13. Illinois: 13%
14. Montana: 12.6%
15. Missouri: 12.5%
15. New Mexico: 12.5%
17. Utah: 12.4%
18. Indiana: 12.3%
19. Alaska: 12.2%
20. West Virginia: 12.1%
21. Kentucky: 12%
22. Idaho: 11.9%
22. Ohio: 11.9%
24. Oregon: 11.8%
25. Connecticut: 11.7%
25. Delaware: 11.7%
25. South Carolina: 11.7%
25. Washington: 11.7%
29. Kansas: 11.5%
30. Pennsylvania: 11.4%
31. Maryland: 11.2%
31. Nebraska: 11.2%
31. New York: 11.2%
34. Michigan: 11%
34. North Carolina: 11%
36. Rhode Island: 10.9%
37. Wisconsin: 10.7%
38. Minnesota: 10.4%
39. Virginia: 10.1%
40. Maine: 9.9%
41. South Dakota: 9.5%
42. New Hampshire: 9.3%
42. North Dakota: 9.3%
44. Massachusetts: 8.9%
45. District of Columbia: 8.8%
46. Iowa: 8.6%
47. Vermont: 8.3%
48. Hawaii: 7.3%
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
