Healthcare Costs Are Now a Voting Issue for Most Americans
Three-quarters of Americans say healthcare will be one of the top three issues deciding how they vote, and the intensity behind that answer is hard to miss. Frustration, overwhelm and helplessness now define the way many people describe the system they use to get care, pay bills and protect coverage.
The People’s Health Care Survey, conducted by United States of Care, reached more than 2,700 registered voters between June 12 and July 16 and was weighted to reflect the U.S. population using recent Census data. The result is a blunt portrait of a system in which affordability is no longer a niche complaint. It has become a political litmus test across party lines, with voters looking for someone to act on costs that keep rising while confidence in institutions keeps eroding.
One sentence captures the pressure point: people are voting with their wallets, and many have already lost ground.
Affordability Frustration Runs Highest in Commercial and Marketplace Coverage
Three-quarters of respondents said they feel frustrated, overwhelmed or helpless about healthcare costs. The burden is heaviest among people with commercial insurance, Marketplace coverage or no insurance at all, where frustration reached 54%, 54% and 49%, respectively. Among people enrolled in Medicare, Medicaid and the VA, frustration fell to just over a third, suggesting that public coverage pathways are buffering some of the financial strain that private coverage often fails to absorb.
Satisfaction with insurance followed a similar pattern, though the survey defined satisfaction in a practical, patient-centered way: not going into debt to get care. By that measure, two-thirds of Medicare beneficiaries and 60% of veterans covered through the VA said they were satisfied with their insurance. Only 42% of people with employer coverage and 40% of Marketplace enrollees said the same.
That gap speaks to a familiar clinical reality. Coverage alone does not guarantee access if deductibles, cost-sharing and prior authorization force patients to defer treatment, ration prescriptions or weigh care against rent and groceries.
Care Delays, Skipped Treatment and Debt Sit at the Center of the Survey
More than half of respondents said healthcare is unaffordable to them, and 49% said it feels more expensive than a year ago. The consequences were not abstract. Only 20% said they paid for care in the past year without difficulty. Another 16% delayed care, 16% skipped care, 12% cut back on food, housing or utilities, and 11% went into debt to pay for care.
Those numbers describe a system that is already altering household behavior. When patients postpone appointments, skip recommended treatment or trade off essentials to cover a medical bill, the effect extends beyond finances. It shows up in disease control, emergency department use and the point at which preventable illness becomes acute illness.
Cost pressure also reaches into employment. Among people with employer coverage, 71% said insurance plays at least some role in job decisions, and one-third said it plays a big role. Health coverage is not just a benefit in this survey; it is part of the labor market calculus.
Voters Want Government Action, Not Industry Self-Regulation
Nearly half of respondents want major or radical change to the healthcare system. Half of those with employer coverage and two-thirds of uninsured respondents fell into that category. Another third want targeted improvements, while 13% want only small fixes. Despite that range, the policy goal remains steady: affordable care, reliable coverage, personalized care and a system that is easier to navigate.
The public is assigning responsibility in a way that carries clear policy implications. Two-thirds of respondents ranked insurers among the top three drivers of high costs, followed by hospitals at 48% and pharmaceutical companies at 46%. The message is straightforward: people do not see rising costs as an accidental byproduct of a complicated system. They see institutions making choices that shape what patients pay and what they can access.
Asked who should make care more affordable, 53% pointed to the president and Congress. Only 19% identified payers as the main responsible group. Partisan differences persisted, but they did not erase the broader pattern. Democrats were most likely to say healthcare would be a top-three voting issue at 89%, followed by Independents at 74% and Republicans at 64%. Support for a large government role in affordability was strongest among Democrats at 66% and Independents at 53%, compared with 39% of Republicans.
Trust Still Runs Through Clinicians, Not Institutions
Trust in the healthcare system is concentrated where patients meet individual clinicians. More than half of respondents fully trust their primary care physician, and nearly half fully trust specialists and nurses. Trust falls sharply from there. Only a quarter fully trust hospitals, 15% fully trust federal health agencies and 12% fully trust insurers and pharmaceutical companies. Trust in AI health tools and elected officials stands at 9%.
That hierarchy matters because patients often judge the system through the people they encounter at the bedside, not through policy statements or corporate messaging. The survey also found that more than a third of respondents checked a recommendation against an outside source in the past year because they did not trust someone in the system. The pattern suggests a widening credibility gap that may help explain why some people increasingly turn to chatbots, alternative sources or politically framed health movements when they want answers.
When a system repeatedly asks patients to absorb financial pain, distrust follows. The survey reflects a public that believes private industry has had enough time to solve the problem on its own and has failed to do so.
Medicaid Coverage Losses Will Be Watched Closely Over the Next Two Years
United States of Care plans to follow about 100 Medicaid beneficiaries in five states over the next two years to examine how the impact of H.R. 1 and Medicaid cuts unfolds. That follow-up will matter because the current survey already shows how fragile coverage feels to many Americans, particularly those on public programs and those living close to a financial edge.
If affordability keeps slipping, the political pressure around healthcare will not ease. It will intensify in clinics, households and voting booths alike.