A recent Commonwealth Fund survey of more than 25,000 U.S. adults found that Americans are struggling to afford health insurance and care.
For journalists, this report offers multiple story angles, including the impact on patients, hospitals, physicians and other providers. Published Aug. 13, the report, “What Americans Want Fixed in Health Care — and Who They Think Should Do It, ”found that 42% of respondents cited high insurance premiums as the most important health care problem, while 36% pointed to high out-of-pocket costs.
The most important story right now may be that health insurance and health care are both unaffordable for many Americans, especially given the high costs of necessities, such as electricity, food, housing, heating fuel and gasoline, according to the Urban Institute. The Commonwealth Fund worked with SSRS, a survey and market research company, to conduct the survey in May.
Patients will need financial assistance
“People were pretty uniform in their viewpoint about affordability, meaning the costs of insurance first, and then the costs of care when they go to use their insurance,” Sara R. Collins said in an interview. Collins is the fund’s senior scholar on expanding coverage and access and tracking health system performance.
When consumers cannot afford insurance or care, they are more likely to skip needed doctor and emergency room visits, she explained. If their conditions worsen, they may seek financial assistance or go into medical debt, she said.
“Hospitals are supposed to have financial assistance programs, but their guidance is often very broad and not well enforced,” Collins explained. Reporters can ask if hospitals consistently help patients in need and whether their financial assistance programs meet state guidelines, she added.
“Some states do more than others in terms of monitoring financial assistance programs,” Collins said. “So much more could be done to require hospitals to offer financial assistance to patients who are unable to pay their out-of-pocket costs and to help them avoid being saddled with unpaid bills.” At Fierce Healthcare, Dave Muoio explained how states could do more to protect patients from medical debt, including by limiting debt collection, requiring hospitals to offer payment plans and expanding financial assistance
Reporters also can check whether nonprofit hospitals spend as much on their communities as they get in tax breaks. In a recent report, the Lown Institute found that in 20 states over three years, 54% of nonprofit hospitals spent less on community investment than they received in tax exemptions, resulting in a total deficit of $11.5 billion.
Lown, a nonpartisan think tank, found wide variations in hospitals’ financial assistance practices at 2,500 hospitals. Patients with identical income and medical needs could get free care at one hospital, but face collections or lawsuits at another. For an example of how journalists can explore these issues, check out this article, “Stories to cover when hospitals hide fees, then sue patients.”
Costs will continue to rise
“Costs are only heading higher, and we know when people can’t afford care, they skip it, putting their health at risk,” Collins explained in the report. “Policymakers should focus on bringing down what people pay, from the premiums that keep climbing to the high out-of-pocket costs they face when they use their coverage.”
In 2027,employers’ health plan medical costs will rise by 9%, which will be among the highest in nearly two decades, the fund showed, citing a report from consultants Pwc. When the costs of care rise, employers shift more of those expenses to workers by increasing deductibles, adding more prior authorization, narrowing networks and cutting benefits, the fund noted.
And changes made by the Trump administration and Congress helped drive up premiums in the Affordable Care Act marketplace by more than 20% this year, the Commonwealth Fund reported in January. Higher ACA premiums have contributed to a drop in enrollment, and insurers are seeking double-digit premium increases for 2027, likely because they suspect healthier people are leaving the marketplace, the report showed.
The loss of healthy members means sicker and costlier enrollees remain, further driving up insurance and health care costs, the fund noted.
Who can bring costs down?
Regardless of political affiliation, nearly half of respondents identified premiums and out-of-pocket costs as their top health care concern.. The Commonwealth Survey found that 45% of Republicans, 44% of Democrats and 42% of Independents said insurance premiums were their top concern, and out-of-pocket costs were second, the report noted.
To address unaffordable health insurance premiums, more than half of respondents (51%) said the federal government was best able to solve the problem, including 65% of Democrats, 49% of Independents, and 36% of Republicans, the report showed. Among Republicans, 40% said health insurers were best able to solve the problem, compared with 28% of Independents and 19% of Democrats.
Resources
- As healthcare costs weigh on patients, states could play a bigger role, report finds, Dave Muoio, Fierce Healthcare, Aug. 17, 2026
- Building on States’ Medical Debt Protections: Closing Gaps in Standards, Access, and Enforcement, The Commonwealth Fund, Aug. 6, 2026
- As Federal Protections Stall, States Move to the Front Lines to Alleviate Medical Debt, The Commonwealth Fund, Jan. 22, 2026.
- Financial Assistance Policy, Hospital Charity Care, and Medical Debt in Collections, JAMA Network Open, Jan. 27, 2026.
- America’s Most Socially Responsible Hospitals, 2026-27, June 23, 2026, the Lown Institute.
- “Past Due: How medical debt is harming Americans and the solutions we need now,” The Lown Institute, June 2, 2025.
- Share of people with a credit bureau record who have medical debt in collections (%), by state, The Commonwealth Fund, 2023.
