Story highlights
- 29% cite health care costs as the most pressing national health issue
- 16% are satisfied with U.S. health care costs. 57% satisfied with out-of-pocket costs
- A record 23% said their health system was in crisis. 47% feel it is a major problem
Americans’ perception of health care costs as the most significant health issue has increased this year to 29%, up from 23% last year. This marks the highest figure recorded since 2004 and is among the highest since tracking began in 1987. Health care costs now surpass access concerns by 17% and obesity by 8% as what Americans see as the primary health problem.
These insights come from the West Health and Gallup Health Survey conducted between November 3 and 25. Typically, cost and access have led concerns in health issues since 2000, but the pandemic shifted focus predominantly to COVID-19. As that concern wanes, issues surrounding cost and access have resurfaced.
Currently, 29% of Americans cite health care costs, which is notably higher than the 16%-27% range observed in the five years leading up to the pandemic, and quite close to the historic high of 30% recorded in 1992. The previous high, also at 29%, was noted in 2004.
While there has been an uptick in concerns about access, it’s still below the 22% recorded in the last pre-pandemic figures from 2018 and the peak of 29% seen in 2007 and 2008.
In terms of specific health issues, after obesity, cancer and mental illness were cited as the top concerns, each at 4%. Mentions of cancer have dropped significantly from 10% pre-pandemic. Mental illness concerns have risen to 7% in 2023, remaining above pre-pandemic levels, which were generally below 3%.
Record-low 16% are satisfied with U.S. health care costs
The low satisfaction regarding health care costs in the U.S. underscores growing worries about affordability. Currently, only 16% express satisfaction with health care costs, the lowest since Gallup started its annual trends in 2001, marking a decline from 19% last year and from a high of 30% at the pandemic’s onset.
In terms of individual costs, 57% of U.S. adults express satisfaction, which is the lowest since 2022. While satisfaction rose during the pandemic, current feelings mirror those from most of the 20 years prior to 2020.
Public sentiment around medical security reveals a contrast; while many view their personal medical security positively, fewer extend that evaluation to national medical security.
Currently, 65% of Americans rate their health insurance positively, slightly below the 68% average since 2001. However, only 24% view national health insurance positively—a decline from 28% last year and the 32% average overall. This positive sentiment for U.S. health insurance is the lowest recorded by Gallup in two decades.
A record 23% say the U.S. health care system is “in crisis”
The increasing worries about health care costs and inadequate insurance ratings have contributed to a record 23% of Americans believing the health care system is in “crisis,” while 47% perceive “significant problems.” Only 26% describe the situation as “minor,” and just 3% assert there are no issues at all with the system.
These results maintain a trend observed since 1994, with a plurality or majority of Americans often citing significant problems in the health care system. The current 23% stating it is in crisis is the highest in Gallup’s history of tracking this issue, exceeding measurements from 2009 and 2013. Compared to last year, more people now view the system as being in crisis (up by 7 points), while fewer see serious issues (down by 7 points).
From 2001 to 2011, views of the health care system fluctuated significantly, particularly following the Affordable Care Act’s passage in 2010, which affected how Republicans and Democrats evaluated the system based on the party in power.
Presently, 81% of Democrats state that health care is either in crisis or has serious problems, increasing by 10 points from last year—matching their highest rating of 84% in 2018 during Donald Trump’s administration. Conversely, Republicans’ negative evaluation has decreased to 64%, down 7 points since last year when Joe Biden took office.
Nearly two-thirds say the government should provide coverage for everyone
When discussing the role of government in health care, 64% of U.S. adults now believe it’s the federal government’s duty to ensure all Americans have access to health insurance. This is the highest percentage since 2007, although support has remained over the majority threshold for roughly a decade.
This belief in government responsibility has seen variations over time; during the Obama era, support for government involvement was often below 50%. In 2013, during the rollout of ACA health exchanges, it sank to 42%. In contrast, the peak support for government coverage was recorded in 2006 at 69%.
The political divide is apparent, with 90% of Democrats and 73% of independents feeling the government should ensure healthcare, while only 26% of Republicans share this view. This 64-point gap between parties reflects one of the widest in 25 years, with independent support currently at a record high compared to other groups.
Conflict of public opinions regarding private and government-run medical systems
While most Americans agree that the government should play a role in ensuring universal healthcare, they are divided on whether the system should be based on private insurance or be government-run. Currently, 48% favor a private insurance framework, while 46% prefer a government-run system, showing a continued split for the second consecutive year.
Since 2010, when tracking began, a majority of Americans have supported private insurance, except for 2017 when opinions were evenly matched.
Democrats continue to showcase strong backing for a government-run system, with 67% in favor, while Republican support remains consistent at 18%, and independent backing has surged to 51%.
Conclusion
Concerns about the U.S. health care system remain high, with costs recognized as the top health issue for the first time in over 20 years. This comes ahead of projected premium increases in 2026 for ACA users, amidst potential legislative inaction from Congress and the president. Reinforcing this worry is record-low satisfaction with U.S. health care costs and declining perceptions of national health insurance, despite many Americans being satisfied with their personal coverage and costs.
These challenges around affordability and overall system effectiveness shape public perceptions significantly, with seven out of ten Americans thinking serious or greater issues exist within the health care system, including a record 23% who deem it in crisis. Partisan dynamics continue to influence these perceptions as well.
Furthermore, the increasing belief that the government should provide health insurance for all Americans is the highest since 2007. Meanwhile, support for the Affordable Care Act appears to be revitalizing, possibly reflecting the collective sentiment as people weigh the options and challenges of the current system against concerns about cost. Despite the growing calls for government responsibility, the division over reliance on private versus government systems is still evident, painting a complex picture of health policy in the U.S. where affordability and satisfaction hang in a delicate balance.
