The index used the responses from multiple questions to place Americans into three categories depending on their access to quality care and ability to pay for care and medicine. In the new data, 49% of U.S. adults were considered “cost secure,” meaning that they had access both to high-quality, affordable care and they had recently been able to afford the care and medicine they needed. In 2021, when the measurement began, 56% of U.S. adults were “cost secure.” That rose to 61% in 2022 but has been falling ever since.

Younger adults, older adults and women were among several groups of Americans that saw drops in healthcare affordability and access in 2025, according to the findings.