Premiums, Out-of-Pocket Costs Top Americans' Health Concerns

Affordability remains the top concern for Americans about their health care with about three-quarters pointing to premiums or out-of-pocket (OOP) costs as the most pressing issue, according to a new survey from The Commonwealth Fund. The responses also showed virtually no difference by political party. Together with its survey partners, SSRS, more than 25,000 US adults were interviewed in May 2026.¹

High-Cost Concerns and Who Should Fix Them

From the conducted survey, affordability was the dominant concern. US adults age 19 and older cited premium costs (42%) and out-of-pocket (OOP) costs (36%), such as deductibles and copays, as the top problem. Far behind, only 15% cited prior authorization and insurance approval as main hurdles, and just 7% cited access and finding a provider as a concern.

Premiums were a main concern specifically for people who pay them directly, such as those with employer coverage, individual or marketplace coverage, Medicare coverage for those 65 years and older, and the uninsured. More than 8 in 10 people with employer, individual, or marketplace coverage, as well as the uninsured, similarly cited high costs as a major concern. Additionally, the findings showed no divide by political party, with similar rates of Republicans, Democrats, and Independents naming cost as the top issue.

As for who can best address the cost of premiums, 51% say the federal government is best positioned, and 41% say the same for OOP costs. Insurance companies are the second-best choice, with 28% support for premiums and 36% for OOP costs, notably close to the federal government's numbers on OOP costs. There was a bigger gap by political affiliation, with 65% of Democrats trusting the federal government versus 36% of Republicans. Results showed Republicans lean more toward trusting insurance companies compared with Democrats or Independents. Independents favored the federal government (49%) over insurers (28%).

“Even among Republicans, a third viewed the federal government as best positioned to address the rising cost of premiums, and there's not a big difference between Republicans who viewed insurance companies as best positioned versus the federal government,” Sara Collins, PhD, senior scholar for expanding coverage and access at the Commonwealth Fund, said in an interview with The American Journal of Managed Care^®.

Behind the Rising Cost of Health Care

Regardless of political affiliation, results show a consensus that Americans are concerned about continuously rising health care costs. The study's authors note that 2027 medical cost trends are projected to be the highest in nearly 2 decades. Employers are shifting more costs to workers through higher cost-sharing, tighter utilization management, reduced drug benefits, and narrower networks. Additionally, Affordable Care Act (ACA) marketplace premiums are up more than 20% in 2026, tied to policy changes under the Trump administration and Congressional Republicans. The expiration of enhanced premium tax credits has driven down marketplace enrollment, along with burdensome marketplace eligibility and enrollment rules and higher OOP costs. Insurers are now requesting further double-digit premium increases, likely because they suspect healthier people have been leaving the marketplace as premiums rise, leaving a sicker, costlier enrollee pool.

“The 21.7 percent increase in ACA premiums likely reflects the same medical care cost trends that have caused premiums in employer-sponsored plans to increase by about 6 percent to 7 percent...,” Holahan and O'Brien wrote in a separate Commonwealth Fund analysis.² “Our colleagues have estimated that the expiration of premium tax credits will result in 7.3 million fewer marketplace enrollees and an increase of 4.8 million Americans without insurance... There will not only be a reduction in enrollees but most likely a less healthy population, meaning more risk for insurers.”

Health Care Affordability Solutions for Policy Makers

To address these concerns, the authors recommended permanently extending the enhanced marketplace subsidies that expired in 2026 and increasing marketplace cost-sharing subsidies. Additionally, they recommended removing eligibility and enrollment barriers in marketplaces and Medicaid. For private plans, they suggested limiting or eliminating deductibles. The authors emphasized that addressing root drivers of costs directly, such as provider prices, rather than continuing to shift costs onto patients and families, could ease the financial burden on Americans.¹

“It will need to be tied to addressing the overall cost drivers in the system. One way of fixing that is by capping what providers are paid closer to what Medicare pays providers,” Collins said.

Americans agree that higher costs are the problem, but they remain split on the solution, and federal policy is currently trending in the opposite direction of reducing high costs. However, Collins argued the fix has to start with Washington.

“It really, again, has to come from the federal government.... Until these drivers are addressed in a very consistent way across the country, we're going to continue to see a decline in affordability among people who get coverage through employers and people who are privately insured,” Collins said.

References

1. Gupta A, Shah A, Richards C, Collins SR. What Americans want fixed in health care — and who they think should do it. To the Point (blog). Commonwealth Fund. August 13, 2026. Accessed August 13, 2026. doi:10.26099/ZHV7-ZT61
2. Holahan J, O'Brien C. Putting the extraordinary increase in ACA premiums in 2026 in perspective. To the Point (blog). Commonwealth Fund. Published January 15, 2026. Accessed August 13, 2026. https://www.commonwealthfund.org/blog/2026/putting-extraordinary-increase-aca-premiums-2026-perspective