A new report from the Peterson Center on Healthcare and KFF, titled “How does cost affect access to healthcare?” explores the significant financial barriers many Americans face when trying to access medical care. Published on April 7, 2025, the analysis uses national survey data to detail what cost barriers exist, why they occur, how they affect people, and who is most vulnerable. According to their website, the report is provided pursuant to a partnership between the two entities designed to “monitor how well the U.S. healthcare system is performing in terms of quality and cost.”

What the Report Examines

A central focus concerns the contradiction between high rates of insurance coverage and the persistent problem of affordability in U.S. healthcare. It opens by establishing that while most adults (92%) have health insurance and a majority (85%) report being in at least good health, many still struggle with the cost of care. The analysis explores several key barriers, including difficulty paying medical bills, delaying or forgoing care due to cost, and worry about future healthcare expenses.

Insurance Design as a Key Obstacle

The analysis points to several underlying causes for these financial barriers. It highlights how even insured individuals face cost barriers due to their insurance plan’s design, based on data from a 2023 KFF Survey of Consumer Experiences with Health Insurance.

The report analyzes problems stemming from insurance, including the following:

• Insurers are paying less than anticipated for medical bills.
• Insurers are not covering care that a patient thought was included in their plan.
• High copayments for prescription drugs.

The report notes the following consequences of such problems:

• 17% of such individuals are experiencing significant delays in receiving medical care or treatment
• 17% of such individuals are not receiving medical care recommended by their provider
• 28% are paying more for treatment or services than they expected to pay.
• 15% of insured adults attribute a decline in their health.

Populations Most Affected

According to the report, the burden of healthcare costs is not born equally, with specific demographic groups facing disproportionately higher barriers as follows:

• The Uninsured: 55% delayed or went without care due to cost, more than double the rate for insured adults (25%).

• Individuals in Worse Health: Adults reporting worse health are nearly twice as likely to forgo care due to cost as those in better health (43% vs. 25%).

• Hispanic and Black Adults: Hispanic (36%) and Black adults (32%) report higher rates of forgoing care due to cost compared to White (25%) and Asian adults (20%).

• Lower-Income Adults: Those with incomes below 200% of the Federal Poverty Level (FPL) are almost twice as likely to go without care as those with higher incomes (40% vs. 23%).

• Non-Elderly Adults (18-64): This group is more likely to delay care due to cost than adults 65 and older (30% vs. 20%), partly due to the availability of Medicare coverage for seniors.

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