Executive Summary

Health care affordability remains a persistent challenge for many Alaska residents. Findings from the Consumer Healthcare Experience State Survey (CHESS) illustrate how high health care costs contribute to delayed care, financial strain, and widespread concern about affording care in the future.

This brief describes findings from a survey of 355 Alaska adults, conducted by Altarum’s Healthcare Value Hub from July 8 – August 31, 2026, to examine experiences with health care affordability burdens, worry about affording care, medical debt, and support for policy solutions.

Key findings include:

• Health care affordability burdens are common: Nearly four in every five (79%) respondents experienced at least one health care affordability burden in the past year.
• Cost leads to delayed or skipped care: Three in four respondents (75%) delayed or went without health care due to cost in the last twelve months.
• Worries about affording care are widespread: Three in four respondents (78%) reported being worried about affording health care in the future.
• Affordability burdens are not evenly experienced: Higher rates of going without care, medical debt and related financial strain were reported by respondents with lower incomes and those with disabilities or disabled household members.
• Broad support for policy solutions: Across party lines, respondents express strong support for policy-based solutions to address high health care costs.

Together, these findings show that health care affordability is a shared challenge affecting access to care and financial security. The findings also highlight broad public support for policies that reduce cost barriers and improve access to affordable care in Alaska.

Background

Health care is expensive in the U.S., and Alaska is no exception. Across the country 71% of all CHESS respondents surveyed have reported some form a health care affordability burden. Despite the fact that the U.S. spends substantially more on health care per person than other high income countries, this higher spending does not consistently translate into better population health outcomes, such as longer life expectancy or lower rates of avoidable illness and death.^1,2,3

Health care costs continue to rise faster than wages and household income,^4,5 placing growing pressure on household budgets. Many of the policies that shape how health care is financed, delivered, and regulated operate at the state level, making states a key arena for addressing affordability.⁶ State‑level data on affordability helps policymakers and advocates understand how national cost pressures are experienced locally, identify which populations face the greatest burden, and evaluate policy options aimed at improving access and reducing financial strain. Detailed information on methods and the respondents who took this survey are available in the Appendix.

A Range of Health Care Affordability Burdens

In Alaska, three in every four (75%) respondents reported that they, or a family member, skipped or delayed medical care due to cost. This figure exceeds the nationwide percentage; 69% of CHESS respondents across all states surveyed reported forgoing or delaying care due to cost. Among those reporting affordability challenges in Alaska, the most common experiences reported were:

• 38% – Delayed going to the doctor or having a procedure done;
• 27% – Cut pills in half, skipped doses of medicine or did not fill a prescription;
• 27% – Skipped a recommended medical test or treatment;
• 18% – Avoided going to the doctor or having a procedure done altogether; and
• 13% – Encountered issues accessing mental health care.

Cost was the most commonly cited reason for delaying or foregoing care (25%). However, other barriers also played a role, including the inability to get an appointment (15%), the service not being covered by insurance (14%), or a lack of transportation to the providers office (13%).

Why This Matters

When people delay or go without care, treatment may occur later than recommended or at a more advanced stage of illness. Prior research shows skipping visits, rationing medications, or postponing recommended services is associated with worsening health outcomes, higher rates of hospitalization, and increased health care costs over.^7,8,9

Differences in Health Care Affordability Burdens

Health care affordability burdens may be experienced differently across income, employment status, insurance coverage, race and ethnicity, age, and disability status. High frequencies of affordability burdens have been reported by CHESS respondents across the country; as a whole, 71% of CHESS respondents across all states surveyed have reported experiencing one or more health care affordability burden(s).

Income and Employment

Respondents living in lower- and middle-income households reported higher rates of affordability burdens than those with higher incomes. In Alaska, nine out of every ten respondents (91%) with an annual household income of between $50,000 and $100,000 reported experiencing at least one health care affordability burden in the last year. These respondents also reported delaying or forgoing care due to cost more frequently than respondents with higher incomes (Figure 1).

Figure 1. Percent of Respondents with Health Care Affordability Burdens, by Income Group

Source: 2026 Poll of Alaska Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Affordability challenges also impact respondents regardless of employment status. Across the board, both respondents who are unemployed but actively seeking work and employed respondents reported high rates of affordability burdens and delaying or forgoing care due to cost.

Figure 2. Percent of Respondents with Health Care Affordability Burdens, by Employment Status

Source: 2026 Poll of Alaska Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Insurance Coverage and Type

Respondents with different forms of coverage reported distinct patterns of cost related barriers, reflecting differences in premiums, cost sharing, and access to covered services. In the National CHESS data set respondents without health insurance coverage, those that purchase their health insurance on the Marketplace, and those on Medicaid experience higher rates of skipping or rationing care. Approximately 22.5% of Alaska’s population is covered by Medicaid or the Children’s Health Insurance Program (CHIP), which provides subsidized health insurance to people with lower incomes or disabilities.¹⁰

The rate of uninsured is particularly high in Alaska (11%).¹¹ However, many Alaska residents receive care through the Indian Health Service (IHS) and the tribal health organizations that provide health services to eligible American Indian or Alaskan Native (AIAN) residents. IHS is not health insurance but is a federally funded care system with no set list of covered benefits, and it pays for care only at tribal and IHS facilities, not wherever a patient goes.

If a service is not available locally, the Purchased/Referred Care (PRC) program can pay an outside provider. PRC is also not an insurance program, and limited funding means it covers emergencies first and may deny or delay other requests. For this reason, AIAN patients are encouraged to enroll in Medicaid, Medicare, or Marketplace coverage in addition to using IHS, since insurance pays for care outside the tribal system and covers services PRC may not approve. Medicaid is a major source of coverage for AIAN people, especially children, and it is one of the main ways the federal government meets its trust responsibility.

When asked to describe their experiences, some survey participants shared personal accounts of being unable to access necessary health care because of cost. While individuals without health insurance coverage often face the most severe affordability burden, respondents with employer-sponsored coverage, individually purchased plans, Medicare, and Medicaid also described difficulties accessing care due to cost (Table 1).

Table 1. Sample Responses to “Please describe a time that you did not get a health care service due to cost in the last twelve months”, by Insurance Type

• “Over the past year, I experienced ongoing mild joint discomfort. My doctor suggested I get a specialized imaging test to check the issue. After checking the price, I found the out-of-pocket cost was far higher than I could afford. I chose to skip scheduling the test and put off further medical evaluation because I could not cover the expense.”
  
• “I planned to get a physical examination last year, but the out-of-pocket expense was too high, so I skipped the check-up.”
  
• “I had to wait to go to a heart specialist at the end of last year after I thought I had a heart attack because my insurance didn’t cover most of the costs.”
  
• “I stopped taking two of my prescription medications because with the rising cost of everything I had to decide if I wanted my medication or to be able to afford necessities like rent, food, etc.”
  
• “I need a dermatologist. The native hospital declined my referral and locally they only treat cancer victims.”
  
• “Due to the rising cost of living and treatment expenses, my wife has had to defer two medical treatments and procedures.”
  
• “My daughter who lives with me had to wait 2 months for a much needed MRI because we couldn’t get an appointment for her here on the island. It took that long for her to get an appointment up on the mainland because IHS would not pay to let her get the MRI here at a different hospital.”
  
• “It wasn’t so much the cost as it is the cost of getting there as clinics aren’t close to my residence.”
  
• “I didn’t get medical attention for a miscarriage due to the cost of the treatment and my insurance having a big out of pocket expense.”
  
• “Have been left without ADHD medication for over 13 years due to the expensive process of accessing mental health professionals, getting screened, and the absurd pricing of getting a prescription. I have moderate to severe ADHD, and every day already feels like I have Alzheimer’s.”

Race and Ethnicity

Nationwide CHESS data demonstrates significant differences in respondents’ ability to afford health care. While 71% of all CHESS respondents across all states surveyed report experiencing any health care affordability burden, this figure increases to 82% of all Hispanic, Latino, Black or African American respondents and 84% of all American Indian or Alaskan Native respondents across all states. American Indian and Alaska Native people make up approximately 20.4% of Alaska’s population, which is the highest percentage of any state in the nation.¹² Respondents of color in Alaska reported slightly higher rates of experiencing any health care affordability burden (82%) or going without care due to cost (79%) than white, non-Hispanic respondents (Table 2).  

Table 2. Percent of Respondents with Select Health Care Affordability Burdens, By Race and Ethnicity

Source: 2026 Poll of Alaska Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
Note: The Respondents of Color category reflects the combined responses from survey participants who are Black or African American, Hispanic or Latino, American Indian or Alaskan Native, Asian, Native Hawaiian or Other Pacific Islander. The response rate for one or more of those demographic categories was not sufficient to report reliable estimates.

Age and Disability

Affordability burdens also varied across age groups. In Alaska, young adults aged 18-44 reported high rates of forgoing care due to cost, though affordability concerns extended across age groups. In fact, ninety-four percent (94%) of respondents between the ages of 35 and 44 reported forgoing care due to cost in the previous year. Young adults aged 18 through 24 (82%) and adults aged 25 through 34 (82%) also reported high rates of going without care.

Respondents with a disability, or who lived with someone with a disability, reported higher rates of health care affordability burdens than those in households without a disability. Among disabled respondents, 90% reported going without some form of care, compared to only 69% of respondents without a disability or who didn’t live in a home with a person with a disability. At the national level, four in five (81%) CHESS respondents with a disability, or who live with a person with a disability, across all states surveyed reported forgoing or delaying care due to cost, compared to 64% of all CHESS respondents across all states surveyed who do not have a disability or do not live with a person with a disability.

Why this Matters

Differences in affordability burdens reflect underlying factors that shape people’s ability to manage health care costs:

• Income: Lower incomes limit the ability to absorb premiums, deductibles, and other out‑of‑pocket costs.^7,13,14
• Employment: Unstable or part‑time employment can reduce access to coverage and contribute to gaps in insurance.¹⁵
• Insurance coverage and type: Plan design, including deductibles and cost sharing, affects out‑of‑pocket exposure, even among insured individuals.¹²
• Age: Younger and working‑age adults may face different affordability pressures than older adults with Medicare coverage.¹⁶
• Disability: Higher health care needs and more frequent service use can lead to greater cumulative costs.¹⁷
Race and ethnicity: Structural differences in income, coverage, and access contribute to disparities in affordability and medical debt.⁷

Together, these factors help explain why affordability challenges are not evenly distributed and highlight the importance of targeted policy approaches to reduce cost barriers.

Encountering Medical Debt

Although many respondents reported delaying, forgoing, or rationing care due to cost, others did receive care but experienced financial hardship from the resulting medical bills. More than a third of respondents (37%) reported experiencing at least one significant financial burden related to medical costs, such as using up all or most of their savings (16%); or being unable to pay for basic necessities like food, heat, or housing (12%); and 13% of respondents reported being contacted by a collection agency in the past year due to medical costs.

Medical debt‑related financial burdens were common among lower- and middle-income respondents, with roughly nearly half (47%) of respondents living in a household earning $50,000 or less and more than half (55%) of respondents in households earning between $50,000 and $75,000 reporting a financial burden due to medical bills. Additionally, more than half (55%) of the respondents with disabilities or disabled household members reported financial burdens due to medical bills; which is a significant difference compared to those without a disability or a disabled household member, of whom 30% reported financial difficulties due to medical bills. Among respondents who reported medical debt, most (65%) reported having health insurance at the time the debt was incurred. The primary reason respondents reported incurring medical debt despite having health insurance is only receiving partial coverage for a service and the remaining bill being too high to reasonably allow them to pay it off.

High Levels of Worry about Affording Care and Coverage

Many respondents in Alaska reported concern about their ability to afford care. These results align with national surveys indicating that concern about affording health care is widespread across the U.S., even among insured adults.^7,11 Across the country, 79% of all CHESS respondents reported being concerned about affording the cost of care. This figure is in line with the percentage of Alaska respondents; 78% of Alaska respondents reported being either “worried” or “very worried” about affording some aspect of care in the future.

Among the list of eleven potential concerns, Alaska respondents most frequently reported being worried about their ability to pay for nursing home or in-home care when needed (59%), their ability to afford medical care in the event of a serious illness or accident (54%), and medical care when elderly (54%). Respondents also reported being worried that their insurance carrier would deny coverage for necessary care (52%), about affording an ambulance ride in an emergency (50%) and affording health insurance itself (48%).

Although concerns about long-term care and medical costs are often associated with older adults, these worries were more frequently reported by younger respondents. For example, 63% of respondents aged 25–34 and 65% of those aged 35–44 expressed concern about being able to afford medical costs when they are older. Likewise, nearly two in three respondents under age 65 (63%) reported being worried about paying for some form of long-term care.

Support for Policy Solutions

Respondents expressed strong support for changes to address high and rising health care costs. Nearly three-quarters (81%) agreed or strongly agreed that “the system needs to change.” When asked which issues the government should prioritize in the coming year, respondents most frequently identified health care (59%), the economy and joblessness (51%), and affordable housing (49%). Among health care-specific priorities, respondents most often selected addressing high health care costs, including ensuring everyone has access to health care coverage (43%), improving affordability in the private health insurance market (33%), and ensuring access to care when needed (33%).

Respondents most frequently identified drug companies (69%), health insurance companies (57%), and hospitals (56%) as responsible for high health care costs, while 51% also viewed medical device manufacturers as playing a role. Support for policy solutions to address health care costs was strong across political affiliations. Respondents across parties endorsed a range of strategies to reduce out-of-pocket costs, increase price transparency, promote competition, and strengthen access to coverage (Table 3).

Table 3. Percent of Respondents Who “Agree” or “Strongly Agree” with Selected Statements, by Political Affiliation

Source: 2026 Poll of Alaska Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Why this Matters

Support for policy solutions across political affiliations indicates that concerns about health care affordability are widely shared. This bipartisan agreement may create opportunities for policy action to reduce out‑of‑pocket costs, increase price transparency, and prevent affordability barriers before they lead to delayed care or financial hardship.

Conclusion

Findings from the Alaska Consumer Healthcare Experience Survey show that high health care costs remain a significant barrier to accessing care and maintaining financial security for many residents. While affordability challenges were widespread, some groups experienced a disproportionate burden.

At the same time, respondents across political affiliations shared common concerns about rising health care costs and expressed broad support for policy approaches to improve affordability, including lowering out‑of‑pocket costs, increasing price transparency, strengthening coverage, and promoting competition.

Together, these findings highlight health care affordability as a shared concern with implications for access, financial security, and long‑term health, and demonstrate how state‑level data can inform efforts to improve access to affordable, high‑quality care.

Notes

1. Peterson-KFF Health System Tracker. (n.d.). Health spending in the U.S. compared to other countries [Chart collection]. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

2. OECD. (2025). Health at a glance 2025. OECD Publishing. https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en.html

3. Commonwealth Fund. (2023, January). U.S. health care from a global perspective, 2022. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

4. KFF. (2022). Health care costs and affordability (Health Policy 101). https://www.kff.org/health-costs/health-policy-101-health-care-costs-and-affordability/

5. Gallup. (2026). One-third of Americans cut back to cover healthcare expenses. https://news.gallup.com/poll/702596/one-third-americans-cut-back-cover-healthcare-expenses.aspx

6. KFF. (2025). Congress and the executive branch and health policy (Health Policy 101). https://www.kff.org/state-health-policy-data/health-policy-101-congress-and-the-executive-branch-and-health-policy/

7. Rakshit, S., McGough, M., & Claxton, G. (2026). How does cost affect access to health care? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/

8. Achterbosch, M., Aksoy, N., Obeng, G. D., Ameyaw, D., Ágh, T., & van Boven, J. F. M. (2025). Clinical and economic consequences of medication nonadherence: A review of systematic reviews. Frontiers in Pharmacology, 16, 1570359. https://doi.org/10.3389/fphar.2025.1570359

9. Gaffney, A., McCormick, D., Dickman, S. L., et al. (2026). Risk of burdensome health care spending over time in the US. JAMA Internal Medicine, 186(2), 203–213. https://doi.org/10.1001/jamainternmed.2025.6948

10. Kaiser Family Foundation. (2024). Health insurance coverage of the total population [State indicator]. https://www.kff.org/other/state-indicator/total-population/

11. America’s Health Rankings. (2025). Analysis of U.S. Census Bureau, American Community Survey, 1-Year Dataset. United Health Foundation. https://www.americashealthrankings.org/explore/measures/HealthInsurance/AK

12. U.S. Census Bureau. (2024). ACS Demographic and Housing Estimates: American Community Survey, ACS 5-Year Estimates Data Profiles, Table DP05. https://data.census.gov/table/ACSDP5Y2024.DP05?q=alaska. Accessed 17 Sep 2026.

13. Sparks, G., Lopes, L., & Montero, A. (2026). Americans’ challenges with health care costs. KFF. https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

14. Collins, S. R., Roy, S., & Masitha, R. (2023). Paying for it: How health care costs and medical debt are making Americans sicker and poorer. Commonwealth Fund. https://www.commonwealthfund.org/publications/surveys/2023/oct/paying-for-it-costs-debt-americans-sicker-poorer-2023-affordability-survey

15. Winger, A., Rae, M., & Claxton, G. (2025). Part-time workers have less access to employer-based coverage than full-time workers. KFF. https://www.kff.org/private-insurance/part-time-workers-have-less-access-to-employer-based-coverage-than-full-time-workers/

16. Cohen, R. A., & Cha, A. E., (2023). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2022 (National Health Statistics Reports No. 180). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/nhsr/nhsr180.pdf

17. Centers for Disease Control and Prevention, Disability and Health Branch. (2024, July 15). Disability impacts all of us [Infographic]. https://www.cdc.gov/disability-and-health/media/pdfs/disability-impacts-all-of-us-infographic.pdf