82M Americans sacrifice food, utilities to afford health care, survey finds

The arithmetic of survival in America has become brutal for millions. When the choice narrows to medicine or food, to a prescription refill or the electric bill, something fundamental has broken in how we organize access to care. A survey released this week by the West Health-Gallup Center on Healthcare in America quantifies what many already know: roughly one in three American adults has recently cut back on essentials—groceries, gasoline, utilities—to pay for medical treatment. Scale that finding across the adult population, and the number reaches 82 million people.

The survey itself was substantial. More than 20,000 respondents answered questions about their financial choices over the preceding year, with data collected between June and August. The researchers then applied those results to the full U.S. adult population, a standard and defensible method for understanding national patterns. What emerged was a portrait of widespread economic strain tied directly to health care costs. The center's own framing was direct: "These findings underscore that health care affordability is not just a health issue: It is a significant economic and societal challenge that affects nearly every aspect of life."

The pressures driving these choices are both immediate and structural. In December, some subsidies provided under the Affordable Care Act expired. Next year, Medicaid work requirements are set to take effect—a combination expected to strip millions of people of affordable insurance coverage. Meanwhile, those with employer-sponsored plans face their own squeeze. Between 2020 and 2025, the average annual cost of family health benefits jumped 26 percent, reaching nearly $27,000 according to the nonprofit KFF. That's not a marginal increase. That's a fundamental shift in what coverage costs.

Within the survey data, specific behaviors emerged that reveal the depth of the problem. Fifteen percent of respondents reported stretching their prescription medications—taking doses less frequently or in smaller amounts—to avoid the expense of refills. This is a particularly dangerous trade-off. It may reduce costs in the short term, but it almost always creates more expensive health crises down the line. As many people borrowed money to pay for care, taking on debt to manage what should be a basic social good.

The burden falls unevenly. People without any insurance were most likely to be making these trade-offs. Lower incomes correlated with greater financial pressure. Those already dealing with worse health faced the steepest challenges. The system, in other words, hits hardest those least able to absorb the blow.

A second survey conducted by the same center between October and December added another dimension to the picture. Nearly 10 percent of respondents—roughly 24 million Americans—reported delaying major life events over the past four years because of health care costs. These were not small choices. They included postponing retirement, putting off home purchases, and deciding not to have children. The decision to delay parenthood, to defer the purchase of a house, to work longer than planned—these are not merely financial adjustments. They reshape the trajectory of a life.

What the surveys capture is a system under stress, with the stress distributed downward onto individuals and families who have fewer resources to absorb it. The question now is whether the policy changes ahead—the expiring subsidies, the new work requirements—will worsen the picture or whether there will be intervention to prevent further deterioration. For 82 million people already making impossible choices, the answer matters enormously.