Nearly half of Americans (47%) fear they won’t be able to afford needed health care in the next year, according to a recent West Health and Gallup report. 

Writing for Gallup in a Nov. 17 article, Ellyn Maese reported that the level of concern is the highest recorded since the group began tracking the issue in 2021 and underscores “widespread and worsening problems” across the country.

The report, “State of the States 2025: Insights on Healthcare in America,” is based on 27 survey questions answered by nearly 20,000 Americans nationwide. It ranks states on the overall healthcare experience and evaluates cost, quality, and access separately. 

Gallup noted sharp state-by-state differences in how Americans experience the system. Iowa and Massachusetts ranked best for overall healthcare experience, while Alaska, Arkansas, and Texas landed near the bottom, according to the data. 

Affordability showed some of the starkest divides across states. Nationally, one in five adults said someone in their household couldn’t afford a prescription in the past three months. In Mississippi, that figure hit 36%, compared with just 12% in Iowa. And while 30% of Americans said someone in their household skipped medical treatment due to cost, the rate drops to 18% in Massachusetts but climbs to 46% in Mississippi.

Quality measures also varied widely, with higher-performing states delivering more proactive care. Seventy-one percent of adults nationwide said their provider ensures they receive recommended screenings and evaluations. That share rises to 78% in Massachusetts and Rhode Island but falls to 59% in Oregon and Wyoming. 

The data on Americans’ access to healthcare showed that a quarter of adults delayed or avoided care because they didn’t know how to find a provider, ranging from 14% in Iowa to 36% in New Mexico. Long wait times, the most common barrier nationwide, delayed or prevented care for 53% of Americans. Vermonters reported the highest delays at 72%, compared with 46% in Nebraska, the top-ranked state.

Overall, Americans gave the healthcare system weak marks: a C overall, with quality and access each receiving a C+. Cost rated lowest, at a D+. No state earned an A in any category.

Maese noted that even with sharp differences between top- and bottom-ranking states, the data reveal that residents in every state are struggling to get the care they need.

“Given these nationwide systemic challenges, every state, regardless of ranking,” she wrote, "has a responsibility to strengthen healthcare delivery."