4 in 5 Americans fear healthcare costs most: report
Nearly four in five United States adults identify high insurance premiums or out-of-pocket spending as the most critical problem in the healthcare system, with the concern cutting across party lines, according to a Commonwealth Fund survey of 25,873 adults conducted from May 4 to May 26, 2026.
Premiums top concern across party lines
Premiums ranked as the top healthcare problem for 45% of Republicans, 44% of Democrats, and 42% of Independents, reflecting bipartisan alignment on an issue that has rarely produced policy consensus.
Among adults with employer, individual, or marketplace coverage, as well as uninsured respondents, more than eight in ten cited premiums or out-of-pocket costs as their primary concern.
The survey was released by the Commonwealth Fund, according to Healthcare Dive, and authored by Avni Gupta, Arnav Shah, Carson Richards, and Sara R. Collins.
“Nearly 4 in 5 U.S. adults said either high insurance premiums or out-of-pocket spending were the most important problem in the healthcare system,” the Commonwealth Fund reported.
High insurance premiums ranked as the top healthcare concern for Republicans (45%), Democrats (44%), and Independents (42%), a partisan gap of just three percentage points.
ACA subsidy expiry pushes costs higher
After enhanced federal subsidies for the Affordable Care Act (ACA) marketplace expired, average out-of-pocket premiums for marketplace plans rose 58% in 2026.
The cost burden is also widening in employer-sponsored coverage: 48% of large employers reported plans to increase workers’ out-of-pocket spending the following year, according to Mercer data cited in the report.
Sara R. Collins, vice president at the Commonwealth Fund and a co-author of the survey, said the scale of the employer cost burden is striking.
“It’s very arresting to me just to think about 24 million people with employer coverage who are living in households that spend a large share of their income on health care costs,” Collins said.
The survey found a political divide on solutions: 65% of Democrats favor federal government action on high premiums, compared with 36% of Republicans, who more often pointed to insurers (40%).
As premium and out-of-pocket cost burdens intensify, healthcare organizations are looking to administrative outsourcing to help manage overhead that feeds into cost structures.
Revenue cycle management (RCM), prior authorization processing, and medical billing are among the functions most frequently contracted to external vendors as providers and payers work to reduce costs without cutting clinical capacity.
Artificial intelligence (AI) tools are accelerating efficiency gains in these workflows, with AI-assisted coding and claims processing reducing turnaround times and denial rates across organizations under cost pressure.
Providers exploring cost reduction strategies can find options among top healthcare outsourcing companies in the U.S., where business process outsourcing (BPO) of administrative functions is a common strategy for institutions operating in a high-cost environment.
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- Record 29% call healthcare costs top U.S. problem, Gallup poll finds · 30 Dec 2025
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