(TNND) — Fewer than half of Americans can consistently access and afford the health care they need for the first time in Gallup tracking.

Just 49% of American adults were considered “cost secure” in an update to the West Health-Gallup Affordability Index.

Tracking only goes back five years, but the share of Americans who can access and afford health care has steadily declined from a peak of 61% in 2022.

A slim majority of Americans are now deemed either “cost insecure” (41%) or “cost desperate” (10%) when it comes to getting and paying for health care.

Simon Haeder, an associate professor of public health at Ohio State University, called the Gallup report a “striking marker” amid ongoing health care concerns. But he said we’ve likely not reached the low point for American health care affordability.

The Gallup report pulled from surveys conducted late last year, before Affordable Care Act, or Obamacare, enhanced tax credits went away.

“I’d expect the 2026 reading to be worse, and possibly meaningfully so,” Haeder said via email.

Gallup said an estimated 2.8 million Americans dropped out of the “cost secure” category last year alone.

With the enhanced Obamacare subsidies gone, health care enrollment has plunged. And Haeder said premiums have reportedly climbed roughly 20% in the wake of that expiration.

“It’s very concerning, but it’s not surprising,” said Mark Hamrick, an economic analyst and the founder of The Hamrick Brief.

A previous Gallup report showed that health care availability and affordability were the top domestic concerns for Americans.

The new report showed even a third of people with high household incomes, those making upwards of nearly $180,000, are either “cost insecure” or “desperate” when it comes to health care.

“Even if you have access, affordability is likely going to come into play when you start thinking about co-pays, out-of-pocket expenses, even for those who have substantial incomes, because these things are very hard to plan for,” Hamrick said. “And this is within the context of an economy where many Americans live paycheck to paycheck. Many Americans do not have sufficient savings, and they lack liquidity.”

Hamrick said the quality of American health care can be “marvelous,” but access is far from guaranteed.

Haeder said health care affordability and access aren’t separate problems. Even cost-secure patients face real friction in their health care, from burdensome travel to dead-end phone calls and other hurdles they must overcome to see a doctor in a timely manner.

Gallup said the youngest adults, those 18-29, are also the least likely to be secure in their health care access and ability to pay. Just 32% fall into that group, a drop from 46% just a few years ago.

Folks who are 65 and older are the most able to access and pay for health care, but the “cost secure” share among them has still dropped to 61% from a peak of 79% in 2022.

Meanwhile, the gap has widened between more-secure men and less-secure women. And Black and Hispanic adults are less secure than white adults.

“When affordability erodes fastest for Black adults, Hispanic adults, and women, you’re watching existing disparities widen rather than narrow,” Haeder said.

A lack of accessible and affordable health care isn’t just a household-level problem, Haeder said. Downstream consequences emerge when a majority of Americans can no longer reliably afford the care they need.

People skip prescriptions, delay doctor visits, and they show up sicker and more expensive to treat down the road.

Haeder offered a few tips for people who are struggling to pay for doctor visits or prescriptions.

Photo by Joe Raedle/Getty Images, file

Ask your clinician directly whether there’s a lower-cost generic or therapeutic alternative, he said.

Use the manufacturer and nonprofit patient-assistance programs and discount tools like GoodRx for medications, since the cash price is sometimes lower than the insured copay, Haeder said.

Community health centers and federally qualified health centers offer sliding-scale fees regardless of insurance status, he said.

But Haeder warned not to ignore medical bills. Hospitals have financial-assistance and charity-care policies that are underused, and bills are often negotiable.

“These are coping mechanisms, not cures,” he said. “The patient-level workarounds don’t fix a system where prices consistently outpace wages. The durable solutions are policy ones. Whether extending the enhanced subsidies, strengthening network adequacy and price transparency rules, or addressing drug pricing.”