Authors: Alexandra Allen, MSPPM, Beth Beaudin-Seiler, PhD

Health care affordability is a top concern for patients, families, and employers, and a leading issue residents want state policymakers to address. High costs strain household budgets, increase stress, and contribute to reduced access to care and poorer health outcomes. Nearly half of U.S. adults struggle to afford care, often delaying treatment, skipping care, or rationing medication—choices that can result in more serious and costly care later. In addition, about four in ten adults carry medical debt, compounding financial hardship and delaying needed care.

U.S. health spending has risen sharply over the past several decades, and nearly one in five dollars spent in the country now goes to health care. High costs reflect a range of economic and policy factors, including higher prices driven by consolidation, fragmentation across public and private payers, and less regulation and price negotiation for medical devices and prescription drugs than in peer countries.

Rising health care costs make it harder for consumers to afford medical care and prescription drugs. Health insurance premiums have long grown faster than both inflation and wages, while out-of-pocket costs reached $1,514 per person in 2023. High out-of-pocket spending can leave low- and moderate-income households facing unmanageable costs, leading to medical debt, delayed care, and difficulty paying for basic needs such as food and housing.

Amid growing concern about the rising cost of living, both Democrats and Republicans have advanced agenda’s centering affordability, including health care. While political polarization and differing ideas about the role of government have shaped the trajectory of health care policy, most consumers believe government has a responsibility to make health care affordable, and there is strong bipartisan support for reducing out-of-pocket costs.

To inform policy discussions and support state policymakers, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Surveys (CHESS) measure public support for a broad range of policy options. Across states, the surveys show strong support for government action across party lines among Democrats, Republicans, and respondents unaffiliated with either major party. This article highlights bipartisan support for policies related to coverage, prescription drugs, price transparency and price regulation, consolidation and competition, health care spending, and access for vulnerable populations—and explains how policymakers and researchers can use these findings to advance affordability.

State Surveys Show Widespread Health Care Affordability Challenges and Support for Change

The Consumer Healthcare Experience State Survey (CHESS) is a population-based survey initiative designed to capture how individuals experience, navigate, and pay for health care. Since its inception in 2018, CHESS has been fielded in sixty-three waves across thirty-seven unique states, producing insights for states on the rates of health care affordability burdens, health care affordability worry, and trouble navigating the health care system occurring in their state.

The CHESS national data set finds that, overall, 72% of survey respondents have experienced at least one health care affordability burden, including skipping care or rationing medication due to cost (69%), and financial burdens such as using up all or most of their savings, sacrificing basic necessities, or incurring medical debt (40%). In total, nearly 8 in 10 respondents are worried about affording health care for themselves and their families in the future (78%). These challenges are more pronounced among people with disabilities, people ages 18-45, low-income people, and Black and Latino people.

The CHESS also consistently finds that, across states, at least 6 in 10 respondents have believed the health care system needs to change and rank health care among the top priorities they want their elected officials to work on. They also believe that high health care costs are driven by a variety of factors, including industry stakeholders like drug companies, hospitals and doctors, insurance companies, and medical device manufacturers, as well as government entities. These findings affirm that people see all of the above stakeholders as holding some amount of responsibility.

Taken together, state survey data provides a compelling foundation for action. By documenting consistent affordability challenges across states, populations, and political affiliations, the CHESS underscores that health care affordability is both a pervasive and broadly recognized problem—one that is well positioned for bipartisan policy solutions.

Expanding Coverage Options

Respondents across political affiliations supported expanding health insurance options so everyone can afford quality coverage (87–95%). Majorities also supported creating an affordable state-based health plan open to any resident, regardless of income or employer-sponsored coverage (83–93%). Several states, including Washington and Nevada, have pursued public option plans aligned with this approach.

Exhibit 1: Respondents Support for Coverage Access Policies by Political Affiliation

Prescription Drug Policies

States are using several policy tools to address prescription drug affordability, including laws that require manufacturers to justify large price increases and allow enforcement against excessive increases. A growing number of states have also created prescription drug affordability boards to review whether high-cost drugs create affordability challenges and in some cases set upper payment limits intended to reduce what public programs pay for drugs.

The data shows that there is bipartisan support for policies that have the power to reduce prescription drug prices, including support for authorizing the Attorney General to take legal action to prevent price gouging or unfair prescription drug hikes (88-92% support across party), prohibiting drug companies from charging more in the U.S. than abroad (88-92% support), and even creating prescription drug affordability boards to establish acceptable costs for drugs (86-93% support).

Exhibit 2: Respondents Support for Prescription Drug Policies by Political Affiliation

Price Transparency and Price Interventions

States have advanced price transparency policies that require hospitals, clinicians, and insurers to provide patients with up-front cost estimates, as well as equipping policymakers with more robust data on health care prices and spending. Surveys showed strong bipartisan support for price transparency initiatives, including requiring doctors and insurers to provide up-front cost estimates for patients and showing what a fair price would be for specific procedures (90 to 94% support across party). While Republican and Democrat lawmakers alike have advocated for consumer-focused price transparency initiatives, there are limitations to price transparency’s impact on consumers as they generally don’t price shop for health care services, and price data is ultimately most useful for researchers, policymakers, and industry stakeholders.

But respondents didn’t stop at price transparency—the majority of respondents across parties also supported direct price interventions as well. States have also pursued direct pricing interventions, including capping out-of-pocket costs for certain medications like insulin, limiting hospital prices in the private insurance market through approaches such as reference pricing, and using premium rate review to regulate prices negotiated between insurers and providers. Survey respondents showed support for these policies as well, including setting standard prices for drugs to make them more affordable (88-93% support across political affiliation) and caping the out-of-pocket costs for life-saving medications like insulin (90-94% support), and even setting standard payments to hospitals for specific procedures (86-92% support). They even showed support for imposing some price controls on contracts between providers and insurers (83% to 92%). This data suggests that state residents are open to both price transparency and direct price intervention regardless of political affiliation.

Exhibit 3: Respondents Support for Pricing Policies by Political Affiliation

Consolidation and Competition

Consolidation is one of the drivers of rising commercial health care prices, with hospitals merging or acquiring independent facilities and then using their market power to negotiate higher prices from insurance companies. These higher prices are then passed on to consumers, with studies showing  20-40% increases in commercial prices in some areas, as well as more expensive facility fees for “hospital-based” care. In response, many states have passed legislation increasing government oversight and regulation of transactions.

Respondents across political affiliations supported policies to address consolidation, including limiting or blocking health care mergers that could reduce competition and raise prices (82–87% support) and setting health care spending growth targets while penalizing payers and providers that exceed them (81–87% support).

Respondents across political affiliations also supported limiting facility fees and adopting site-neutral payment reforms, including preventing hospitals from charging more for routine services typically provided in physicians’ offices (90–92% support) and prohibiting fees unrelated to the cost of care, such as facility charges at clinics far from a hospital campus (90–93% support).

Exhibit 4: Respondents Support for Consolidation and Fees/Payment Policies by Political Affiliation

Shaping Health Care Spending

Several states have adopted health care spending benchmarks/targets tied to the broader economy, in some cases requiring corrective action when payers or providers exceed those targets, as with Massachusetts. Some states are also using primary care spending benchmarks to increase investment in primary care as a share of total health spending, based on the view that stronger primary care can improve access, outcomes, and long-term affordability.

Surveys showed modest bipartisan support for these kinds of interventions, including setting limits on health care spending growth and penalizing payers or providers that fail to curb excessive spending (81-87% support across party) and increasing investment in primary care (87-93% support) including requiring health care providers to spend a certain amount on primary care services (80-87% support).

Exhibit 5: Respondents Support for Health Care Spending Policies by Political Affiliation

Affordable Care for Vulnerable Groups

Recent federal policy changes following the passage of H.R.1 are expected to compound affordability challenges for Medicaid enrollees over the next several years, including eligibility and enrollment restrictions, limits on provider reimbursement that could reduce Medicaid network participation, and funding reductions risking cuts to optional benefits like home and community-based services.

The CHESS data show bipartisan support over time for policies that would reduce some of these challenges, including making it easier for people to apply for and renew their Medicaid coverage (82-87% support across political affiliation), increasing reimbursement rates to incentivize health care professionals to participate in Medicaid (82-90% support), and funding home and community-based programs for people with disabilities (86-93% support).

Exhibit 6: Respondents Support for Care Access Policies by Political Affiliation

Embrace Bipartisan Support for Health Care Policy Change

CHESS data show that, despite differences in how people view the health care system, everyday Democrats, Republicans, and others share many of the same affordability challenges and support many of the same solutions. Across coverage expansion, price interventions, competition, and spending policies, the surveys point to a meaningful base of bipartisan support. Even in a polarized environment, health care costs affect households across the political spectrum, and affordability remains a practical area for policy action.

Both Democrat and Republican policymakers should take this as evidence of bipartisan support for diverse affordability strategies that reflect their states’ needs and policy environments. Health policy advocates and researchers can support this effort by drawing on these results to demonstrate broad public support for a range of health care affordability solutions that at times defy partisan expectations.

The United States healthcare system is indeed in a crisis of affordability, and policymakers across the political spectrum have a responsibility to honor the needs and beliefs of their constituents. Everyday people are ready for the government to take decisive action on health care affordability, and policymakers should answer the call.