Why It Matters
A sweeping new survey shows healthcare affordability remains a serious burden across the United States, with nearly half of working-age adults reporting they or a family member faced cost-related barriers to care. The findings carry particular weight in Maryland and other states with large Medicaid and Marketplace populations, where coverage gaps and rising premiums continue to strain households.
What Happened
The Urban Institute released a report on healthcare affordability challenges this week, drawing on a December 2025 survey of 10,000 working-age U.S. adults funded by the Robert Wood Johnson Foundation. The research found that 46 percent of respondents experienced at least one affordability problem — defined as trouble paying medical bills, a family member going without needed care due to costs, or carrying medical debt.
Uninsured adults faced the steepest barriers, with 60 percent reporting affordability problems. But the survey found significant challenges even among insured populations: 57 percent of Medicaid enrollees, 54 percent of those with Marketplace coverage, and 40 percent of adults with employer-sponsored insurance all reported struggling with costs.
Thirty-five percent of all adults surveyed said a family member had gone without needed healthcare because of the expense.
By the Numbers
69% — Adults with disabilities reporting affordability troubles, compared to 40 percent of adults without disabilities.
70% — Share of people with strokes or with COPD, chronic bronchitis, or emphysema reporting affordability problems. People with cancer or heart disease reported problems at 64 percent.
50% — Adults in the South reporting affordability challenges, compared to 45 percent in urban areas. Rural adults reported difficulties at roughly the same rate as those in Southern states.
42% — White adults struggling to afford care, versus 28 percent of Asian adults. Black and Hispanic adults reported majorities facing affordability problems.
$1,000 — The per-person increase in average Marketplace deductibles, according to KFF, a health policy research organization. About one in five adults with private insurance reported experiencing a large premium increase, with Marketplace enrollees nearly twice as likely as employer-coverage holders to report such increases.
Zoom Out
The findings reflect a persistent national trend: even as coverage rates have expanded in recent years through Medicaid and the Affordable Care Act’s Marketplace, out-of-pocket costs and premiums have climbed, eroding the practical value of insurance for many enrollees. The data suggest geographic and demographic disparities remain deeply embedded in the system — with Southerners, rural residents, people with chronic conditions, and racial minorities disproportionately affected.
The affordability picture is unfolding alongside broader economic pressures. In Maryland, where federal workforce reductions have strained household budgets, faith communities have stepped in to serve federal workers affected by last year’s layoffs, and state homelessness rose 17 percent according to the most recent national count — conditions that tend to compound healthcare access challenges.
What’s Next
The Urban Institute report arrives as Congress debates the future of enhanced Marketplace subsidies originally enacted under the American Rescue Plan, which are set to expire. If those subsidies lapse, premiums for Marketplace enrollees are expected to rise further, potentially worsening the affordability gaps the survey documents. Advocates and policy researchers are expected to use the findings to press for legislative action ahead of any subsidy cliff. No specific congressional votes are currently scheduled.