2021 Report

Healthcare in America

As the second year of a once-in-a-century pandemic comes to a close, Americans’ view of the healthcare system is steeped in growing fear and worry about rising costs and inequities in the U.S. healthcare system. The 2021 Healthcare in America Report details the experiences of an American public that is increasingly burdened by high healthcare costs and growing more and more pessimistic about the future of the nation’s healthcare system.

Executive Summary


At the close of 2021, Americans report a growing struggle to pay for healthcare, increasing concerns about inequities and access in the U.S. healthcare system, and little faith the federal government will enact reform to make things better anytime soon. Irrespective of race, gender, or income, Americans are more burdened by and worried about healthcare costs.

While these issues are not necessarily new, the degree to which they have been heightened or exacerbated by COVID-19 are at an all-time high since the beginning of the pandemic, according to measurements by West Health-Gallup. The 2021 Healthcare in America Report, drawn from a nationally representative sample of more than 6,600 U.S. adults, tracks changes in public attitudes throughout the year and details a relentless progression of affordability challenges across all race, gender, and income brackets.

The report, one of the largest surveys conducted during the pandemic on the public perceptions of the U.S. healthcare system, provides a comprehensive look at changing attitudes, behaviors, and trends in healthcare.

Explore the full report


Americans who say their view of the U.S. healthcare system worsened due to the pandemic


Number of Americans (15%) who report greater difficulties in paying for healthcare


Number of Americans who characterize the U.S. healthcare systems as expensive and broken


One out of 20 adults say friend or family member died because they couldn’t afford medical treatment


Report Highlights

Negative perceptions of the U.S. healthcare system related to cost, quality and access grew dramatically over the course of the COVID-19 pandemic

Nearly half (48%) of all Americans say their view of the U.S. healthcare system worsened due to the pandemic


An estimated 38 million Americans (15%) report greater difficulties in paying for healthcare


Sixty percent of Americans report that the pandemic has made them more concerned about unequal access to care, a concern that rises to nearly 3 in 4 Black Americans and 2 in 3 Hispanic Americans

The number of Americans who are unable to access treatment or medicine because of cost is rising quickly

Nearly one-third of Americans report not seeking treatment for a health problem in the prior three months due to its cost, a percentage that has tripled since March


Even among higher-income households (those earning above $120,000 annually), 20% report not seeking care in the prior three months because of its cost – up from about 3% in March


One-fifth of U.S. adults (21%) report they or a member of their household had a health problem worsen after postponing care because of cost                   


Almost a third of U.S. adults (30%) report that they would not have access to affordable care if they needed it today, up from 18% in February and 22% in June


Forty-two percent of U.S. adults are concerned they will be unable to pay for needed healthcare services in the next year

Few Americans believe they receive good value when weighing the quality of care against the cost

An estimated 58 million U.S. adults (23%) say that healthcare costs are a major financial burden for their families


Younger Americans (under 50) and households with yearly income less than $48,000 are most burdened financially by healthcare costs


Seven in 10 Americans (71%) agree that their household pays too much for the quality of healthcare they receive, an 11-point increase between April and October

Powerless and pessimistic are feelings shared by all Americans, even across political party lines

Two-thirds of U.S. adults (66%) think voters have very little to no power in reducing the cost of healthcare in the U.S., but nearly nine in 10 think American businesses, corporations and the U.S. Congress do


However, more than two-thirds of Americans, regardless of party affiliation, say they are pessimistic about the federal government enacting policies to reduce healthcare costs in the coming year

There’s clear disparity in the deadly consequences of skipping critical care

An estimated 12.7 million Americans report knowing a friend or family member who died this past year after not receiving treatment because they could not afford it


Black Americans (8%) are twice as likely to know someone who died after not receiving care due to cost as White Americans (4%)


America Speaks

“Expensive,” “Broken,” and “Unfair”
West Health and Gallup began the survey with a simple prompt for Americans: describe the U.S. healthcare system in “three words or short phrases. Nearly 50% of respondents used one of these three words. The harsh descriptors are a sharp contrast to a 2019 West Health and Gallup survey on U.S. healthcare costs in which close to half (48%) of Americans believed the quality of care found in the U.S. was either the “best in the world” or “among the best.”


Review, analyze, compare, and share the complete data sets through the downloads below to verify and explore new insights.


Access and review the full data and demographic cuts by question. Download here.


State-level data sets include in-depth reports from California, New York, Florida, Pennsylvania, and Texas alongside national trends. Download here.





Results are based on a survey conducted by web over successive field periods of Sept. 27-30 and Oct. 18-21 with 6,663 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia as a part of the Gallup Panel. For results based on these monthly samples of national adults, the margin of sampling error at the 95% confidence level is +1.5 percentage points for response percentages around 50% and is +0.9 percentage points for response percentages around 10% or 90%, design effect included. For reported sub-groups such as by age, political identity, household income, or race/ethnicity, the margin of error will be larger, typically ranging from ±3 to ±5 percentage points.


The final report can be found here