Affordability trends shaping U.S. health care

Key considerations for navigating cost, access and care delivery

Rising health care costs are rapidly pushing affordability to the forefront of U.S. health policy, as financial pressure on households continues to intensify. 

According to Centers for Medicare and Medicaid Services’ National Health Expenditure data in 2024, out-of-pocket health spending reached $556.6 billion nationwide and averaged $1,632 per person, underscoring how rising premiums, deductibles and copays are showing up directly in family budgets. These out-of-pocket costs are climbing alongside other essential expenses such as housing, food and transportation, sometimes forcing households to make difficult trade-offs. 

As a result, health care spending often competes with basic living needs, leading some individuals to delay or reduce necessary care decisions that can have serious financial and clinical consequences over time.

Impact on the consumer

The impact of high costs extends well beyond household budgets, directly influencing access to care and long-term health outcomes. When patients skip physician visits, delay diagnostic testing or avoid filling prescriptions due to cost concerns, manageable conditions can escalate into more severe and expensive health issues. This pattern not only increases the complexity of treatment but also contributes to preventable complications and higher overall system costs. In this way, affordability is no longer just a financial issue it becomes a central public health concern that shapes population health, care utilization patterns and long-term sustainability.

At the same time, health care affordability presents a complex challenge for policymakers and industry stakeholders alike. Insurers, employers, hospitals and regulators are all under pressure to slow cost growth while maintaining access and quality. Each group faces competing incentive balancing financial performance, regulatory compliance and consumer expectations making meaningful reform difficult to achieve. For patients, these dynamics translate into frustration and uncertainty, while for organizations, they create urgency around innovation in care delivery, pricing transparency and alternative payment models such as value-based care.

Market and policy responses are beginning to take shape, but progress remains uneven. Employers are exploring high-performance networks and direct contracting, insurers are refining benefit designs and care management strategies, and providers are investing in efficiency and digital health solutions.

According to Kaiser Family Fund, the pressure to act is clear: employer-sponsored family health coverage averaged $25,572 in annual premiums in 2024, and 32% of covered workers were enrolled in plans with a general annual deductible of $2,000 or more.  These rising premiums and high deductibles signal a growing cost burden shift from employers to employees, directly affecting access to care and financial stability for working families. As a result, affordability is no longer just a pricing issue but a central driver of health care utilization patterns, plan design innovation and policy reform across the U.S. health care landscape.

Meanwhile, policymakers are advancing transparency requirements, drug pricing reforms and payment model demonstrations aimed at improving value. However, without stronger alignment across stakeholders, these efforts could risk fragmentation and limited impact, underscoring the need for coordinated strategies that prioritize both affordability and outcomes.

Looking forward

Tackling health care affordability will require coordinated action across care delivery, payment models and public policy. Health care leaders should consider the following:

• Advance care and payment models: Continue the shift toward valuebased care while improving price transparency through data that is relevant, actionable, and decisionuseful.
• Expand access to preventive and primary care: Emphasize earlier and more consistent care to support better outcomes and moderate longterm cost growth.
• Align incentives across stakeholders: Improve alignment among payers, providers, and employers to support affordability and valuefocused decisionmaking.
• Address underlying cost drivers: Ongoing attention to structural cost pressures—such as pharmaceutical pricing and hospital consolidation—will remain an important part of affordability discussions, alongside efforts to preserve access, quality, and innovation.