Healthcare Affordability
Understand how a high-priced healthcare system effects Americans and policy solutions that can help them overcome the challenges.
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What Is Medicaid? A Guide to Qualifications, What It Covers, & Costs
Key Takeaways: Medicaid covers 74M+ Americans, 41% of U.S. births, and 5 in 8 nursing home residents, making it the largest health insurer in the U.S. Eligibility combines federal rules with state variation; expansion states cover adults up to 138% of the federal poverty level. Mandatory benefits include hospital care, physician services, and nursing facility care; dental, vision, and prescription...
Prescription Drug Costs: Plans, Coverage, & Other Price-Driving Factors
Key Takeaways: U.S. prescription drug spending hit $805.9 billion in 2024, with prices averaging 2.78x higher than 33 other OECD nations. High costs stem from manufacturer pricing power, patent thickets, opaque PBM rebates, and insurance cost-sharing tied to list prices. The IRA capped Medicare Part D out-of-pocket costs at $2,100 in 2026 and enabled the first round of Medicare drug price negotiat...
Protecting Patients from Unexpected Outpatient Facility Fees
In recent years, health care consumers, payers, and policymakers have brought attention to the growing prevalence of hospital outpatient facility fees in the United States. As hospitals and health systems expand their ownership and control of ambulatory care practices, they are typically charging new facility fees for services delivered in these outpatient settings. Consumers, too, are facing grea...
How H.R. 1, The One Big Beautiful Bill Act, Reshapes Healthcare for Older Adults
H.R. 1, or the One Big Beautiful Bill Act (OBBBA) was signed into law on July 4, 2025. The legislation introduced wide-ranging reforms across Medicaid and Medicare, with significant implications for how states finance and deliver care to older adults. In addition, OBBBA includes changes to social services, such as the Supplemental Nutrition Assistance Program (SNAP), and provides funding for trans...
American Exceptionalism
Americans pay substantially more for prescription drugs than people in other high-income countries, often three to four times as much, even though they use fewer medications and have worse overall health outcomes. This gap has been known for decades, but policy efforts have not significantly reduced prices. The problem is rooted in the structure of the U.S. healthcare system rather than difference...
Key Challenges Women Face that Impact Their Financial Security
Planning for retirement is difficult at any age, but it can be especially challenging for women ages 50 to 64, who are often juggling work, caregiving responsibilities, and rising health expenses associated with an increase in health care needs. These years are also often women’s peak earning years, making this period a critical window to build savings and strengthen financial security. Elder Inde...
Tracking Healthcare Affordability and Value
The percentage of Americans who can afford and access prescription drugs and quality healthcare stands at a new low of 55%, a six-point decline since 2022, according to the West Health-Gallup Healthcare Affordability Index. The index was developed in 2021 to track the percentage of Americans who say they have avoided medical care or not filled prescription medications in the last three months, and...
Same Service, Same Price: Promoting Policies That Curb Unfair Billing Practices and Increase Price Transparency for Health Care Services
Rising prices for everyday goods and services are burdening American households, and health care services are no exception, with more than 100 million Americans impacted by medical debt. The high and rising cost of health care and surprise medical bills can be attributed in part to inequities in cost for the same services and procedures performed at different medical facilities. Concern is growing...
Executive Summary | Pharmacy Benefit Manager Reforms: Can Congress Fix the Market Without Breaking It?
Pharmacy benefit managers (PBMs) play a central role in determining access and spending for prescription drugs in the United States. PBMs earn revenues from negotiating price and payment concessions from the prescription drug supply chain — pharmaceutical companies and pharmacies — on behalf of health plans. This arrangement encourages them to control prescription drug prices and spending but has ...
Benchmarking Healthcare Affordability and Perceived Value
Americans are finding it increasingly harder to pay for healthcare. Over the past year, the percentage of Americans who report skipping needed care due to cost has increased to 30%. Meanwhile, nearly the same percentage of Americans, 29%, report that they could not access affordable care if they needed it today. But a lack of affordability is not the only issue affecting Americans’ experiences wit...