Americans are bracing for a health care system they increasingly feel is failing them. A new survey from West Health and Gallup finds anxiety over impending medical costs at its highest point since the firms began tracking these concerns four years ago—a sign that health care may once again define a midterm cycle.
For the Democratic Party, the numbers offer something close to validation. During the GOP’s government shutdown, Democrats worked to shore up and extend protections, while Republicans pushed to unwind them. This survey suggests voters noticed, and that the issue isn’t going away.
Almost half of adults—47%—are worried they won’t be able to afford health care next year. That’s the largest share since 2021. Anxiety over prescription drugs has climbed, too, from 30% in 2021 to 37% now.
The daily strain is worsening. Fifteen percent of Americans say medical costs cause “a lot of stress” in their lives, nearly double the rate from three years ago. Three in 10 adults report that someone in their household skipped care because they couldn’t afford it. And the disparities are staggering: Only 18% of Massachusetts residents say a household member skipped treatment due to cost, compared with 46% in Mississippi.
Access problems go beyond money, though. Long waits for appointments are among the most common obstacles, delaying or preventing care for 53% of adults. In Vermont, that figure hits 72%, but even in Nebraska—the state with the best rating on this issue—it’s 46%.
An insurance agent talks with clients in Miami in 2023.
These concerns are already shaping the congressional fight over whether to renew enhanced Affordable Care Act tax credits. Only about half of U.S. adults—51%—believe basic health care is affordable and accessible, a 10-percentage-point drop since 2022. The decline is even sharper among Black (-13 points) and Hispanic Americans (-17 points).
Trump, meanwhile, didn’t exactly calm nerves this week for voters staring down rising premiums and deductibles.
On Tuesday, he blasted out a baffling Truth Social post insisting that the only health care plan he’d “SUPPORT OR APPROVE” is one that sends money “DIRECTLY BACK TO THE PEOPLE,” because “RICH INSURANCE COMPANIES” have “RIPPED OFF AMERICA LONG ENOUGH.”
“THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE,” he continued. “Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!!”
The plan is, of course, nonsensical. Handing people cash to buy coverage would funnel the money back to insurers—the very industry he claims he wants to sideline. And the idea that stressed-out, overworked Americans are eager to cold-call insurance companies to negotiate rates is pulled straight from his “businessman” worldview—entirely unattached from the reality of the U.S. health system and the lived experience of the vast majority of Americans.
It also raises an obvious question: How is a low-income patient supposed to strike a better deal than the federal government?
Trump’s harebrained idea underscores just how far removed he is from the anxieties captured in the West Health-Gallup survey—and why the health care issue may lift Democrats’ chances in the 2026 midterm elections.
West Health and Gallup also tallied self-reported health care experiences in every state and Washington, D.C., and the gaps are striking. Iowa ranks best overall based on the combined ratings for cost, quality, and access. And Alaska falls dead last.
Even in the strongest-performing states, though, cracks show. Iowa’s top overall rating is still just a “C+.” And 15% of adults in the 10 top-rated states say they have forgone necessary prescription drugs in the past three months. In the 10 lowest-ranked states, that jumps to 29%.
Skipping care has become routine nationwide. One quarter of adults in the best-ranked states avoided recommended tests or procedures because of cost in the past year. And in low-ranked places—such as Alaska, Montana, and Texas—the share climbs to 40% on average.
And beyond cost, Americans describe a system buckling under its own weight. Twenty-seven percent of adults blamed work schedules for their restricted access to care—a reminder that insurance alone doesn’t guarantee access. And confusion about where to find providers is widespread: 25% of adults in the top-ranked states and 31% in the lowest-ranked states say they don’t know where to go for care.
All of it adds up to a troubling picture heading into 2026. Enhanced ACA subsidies are set to expire on Dec. 31, while Medicaid work requirements go into effect in January 2027—changes researchers say could cause nearly 5 million more people to go uninsured.
Pair those shifts with a mounting affordability crisis, and the next few years could push millions further from the care they need.
For Democrats, the poll reads like a permission slip to double down. Health care is the one issue they pressed relentlessly during the GOP’s shutdown—both because the stakes were high and because they believed Republicans had left themselves exposed. The new data suggests they were right.
And Trump’s latest musings only sharpen the contrast. While he flirts with a deregulation fantasy that hinges on ordinary people negotiating their own insurance, Democrats are preparing to make rising costs and eroding protections a centerpiece of their midterm case.
If the West Health-Gallup numbers are any indication, voters are primed to hear their pitch.
