• Posted December 23, 2025

A Quarter Of American Families Face Financially Overwhelming Medical Expenses

More than 1 in 4 Americans are struggling with financial toxicity, with big medical bills dragging down both their money and their health, a new study says.

Nearly 27% of U.S. residents faced high medical expenses or skipped needed health care because they couldn’t afford it between 2018 and 2022, researchers reported Monday in JAMA Internal Medicine.

Additionally, more than half (53%) of people who died during that period racked up overwhelming medical bills, researchers found.

“Health care is even less affordable than previous studies have suggested. They’ve only looked at how many people are hit by unaffordable health care over one year. But the risks mount over time,” said lead researcher Dr. Adam Gaffney, an assistant professor at Harvard Medical School.

“And high medical costs don’t just devastate finances, they force people to skip care — which often further worsens their health,” Gaffney added in a news release.

For the study, researchers tracked data on more than 12,600 Americans participating in the Medical Expenditure Panel Survey, a federal project that tracks the cost of health care in the U.S.

The team looked specifically at three widely used measures of unaffordable health care:

• “Cost burden,” or out-of pocket costs greater than 10% of family income or greater than 5% of income among the poor

• “Catastrophic cost burden,” or health spending greater than 40% of family income excluding food costs

• “Foregone care due to cost,” or skipping needed care because it was unaffordable

Results showed that the number of people who experienced each of these financial stresses rose as time passed.

For example, just under 4% of people incurred catastrophic costs within one year, but 10% experienced them after four years.

Likewise, under 6% of adults went without needed care during a single year, but over a four-year span, 12% wound up skipping care.

Overall, the share of people who experienced at least one of the three markers of unaffordable care rose from around 12% after one year to nearly 27% by the end of the fourth year.

People with incomes lower than 200% of the poverty line — $64,300 for a family of four – were nearly nine times more likely to incur catastrophic costs than America’s wealthiest, results showed.

Other groups most at risk included adults without a college degree, older adults, anyone who was hospitalized, and those with chronic health problems like asthma or high blood pressure.

“If you’re not a billionaire you’re just one serious illness away from financial ruin. Even if you don’t need much care this year, you’ll get sick or injured at some point, and then the medical bills will pour in,” senior researcher Dr. Steffie Woolhandler, a professor of public health at CUNY’s Hunter College, said in a news release.

“And health care is set to become even less affordable, with enhanced [Affordable Care Act] subsidies expiring and Trump’s deep Medicaid cuts ahead,” Woolhandler added.

There’s one clear solution to the problem, Gaffney said.

“It’s time America joined other nations and implemented national health insurance,” he said. “That would save hundreds of billions on insurance paperwork and profits, savings that we could use to provide the complete coverage needed to protect families’ finances as well as their health.”

More information

KFF has more on Americans' challenges with health care costs.

SOURCE: Harvard Medical School, news release, Dec. 22, 2025