A new survey has found that the rising cost of health insurance premiums and out-of-pocket medical expenses is the biggest healthcare concern among Americans.
The survey, conducted by The Commonwealth Fund with more than 25,000 adults in May 2026, showed that healthcare affordability remains a major concern across political parties and different types of insurance coverage. Premium costs were identified as the biggest problem by 42% of adults, while 36% pointed to out-of-pocket expenses such as deductibles and copayments .
The findings highlight the growing pressure many people face when trying to pay for healthcare. Even people with health insurance can still face significant costs when they visit hospitals, see doctors, buy prescription medicines or receive specialised treatment.
The survey found that nearly four in five adults considered either high insurance premiums or out-of-pocket spending to be the most important problem affecting the healthcare system. The concern was shared by Republicans, Democrats and Independents, showing that the high cost of healthcare remains an issue affecting people across political lines.
Health insurance premiums are the regular payments people make to maintain their insurance coverage. However, having insurance does not always mean that all medical expenses are fully covered. Patients may still be required to pay deductibles before some benefits begin, as well as copayments and other charges when receiving care.
These additional expenses can become a serious burden, particularly for people who require frequent medical treatment or need expensive medicines. The survey found that affordability was a greater concern than other healthcare challenges, including problems with prior authorisation and difficulties finding healthcare providers.
More than eight in 10 people with employer-sponsored insurance, individual or marketplace coverage, as well as uninsured adults, identified high healthcare costs as a major concern. This suggests that the problem goes beyond one particular group and affects people with different experiences of the American healthcare system .
The survey also asked respondents who they believed was best positioned to address these financial challenges. About 51% said the federal government was best placed to deal with high insurance premiums, while 41% chose the federal government as the institution best able to tackle out-of-pocket costs.
Insurance companies were the second most frequently selected option. Around 28% believed insurers were best placed to address premium costs, while 36% selected them as the best option for reducing out-of-pocket expenses.
However, opinions differed when respondents were grouped by political affiliation. Democrats were more likely to say the federal government should take the lead, while Republicans were more likely to place greater responsibility on insurance companies. The findings do not indicate support for any particular healthcare policy but show broad agreement that affordability is a serious problem.
The survey comes as many Americans continue to face rising healthcare costs. Reports have also shown significant increases in 2026 health insurance costs in the Affordable Care Act marketplace, with the expiration of enhanced premium tax credits contributing to higher expenses for many consumers. The Commonwealth Fund reported that ACA premiums increased by an average of 21.7% in 2026 .
Rising costs can have important consequences for public health. When healthcare becomes too expensive, some people may delay seeing a doctor, postpone tests or avoid filling prescriptions. This can allow health problems to worsen before treatment is received, potentially leading to more serious medical and financial consequences.
The survey therefore places renewed attention on one of the biggest challenges facing the US healthcare system: how to make medical care and insurance more affordable. While Americans may disagree about who should solve the problem, the findings show strong agreement that the cost of premiums and out-of-pocket expenses needs urgent attention.
As healthcare costs continue to rise, policymakers, insurers, employers and healthcare providers will face increasing pressure to find ways to reduce the financial burden on patients. For millions of Americans, the question is no longer simply whether healthcare is available, but whether they can afford to use it when they need it most.
