What Americans Want Fixed in Health Care — and Who They Think Should Do It

Introduction

Millions of Americans aren’t able to get and afford the care they need, find appropriate medical providers in their area, or get help managing their conditions. The U.S.’s high health care costs, lack of universal coverage, severe health inequities, and poor long-term health outcomes impede many Americans’ ability to get and stay healthy over their lifetimes. In a new survey, the Commonwealth Fund asked people to identify what they think are the most important problems in the health care system and who should be best able to solve them.

With our survey partners, SSRS, we interviewed more than 25,000 U.S. adults in May 2026. Americans ranked the high cost of health insurance and health care as top concerns, regardless of their political party, with opinions split on who can best address the problems. For more information on the survey itself, see “How We Conducted This Survey.”

Findings

Americans across all insurance types and political affiliations say that the cost of health insurance and health care are the most important problems to solve in the health care system.

The affordability of health care was the dominant concern among U.S. adults, with about three-quarters identifying either the cost of premiums or high out-of-pocket costs as the most important problem in the U.S. health care system. Forty-two percent identified high insurance premium costs as the top problem and 36 percent said high out-of-pocket-costs — or the costs people pay when they get medical care or fill prescriptions, including deductibles and copayments — was the most-pressing problem.

Premiums were the top concern for people who pay them (i.e., those with employer coverage, individual or marketplace coverage, and those age 65 and older with Medicare coverage) as well as for people without insurance. Concern about costs, including premiums and out-of-pocket spending, were highest among people with employer, individual, or marketplace coverage, and the uninsured. More than eight of 10 people with these forms of coverage cited these costs.

There is no political divide over top concerns, with similar rates of Republicans, Democrats, and Independents saying insurance premiums and out-of-pocket costs are the top problems, by a wide margin.

Half of Americans say the federal government is best able to address high health care cost problems.

The federal government is viewed as the best entity to address health care cost concerns. Among U.S. adults age 19 and older who selected each of the cost concerns as the most important issue, half said the federal government was best able to address the high cost of insurance premiums; four of 10 said the federal government is best able to take on high out-of-pocket costs.

While most Democrats (65%) think the federal government is best able to solve health care cost problems, this view had bipartisan appeal. Roughly one third of Republicans (36%) also selected the federal government as best positioned to address cost-related problems and Independents were more likely to select the federal government (49%) than insurance companies (28%). Notably, however, Republicans were more likely than Democrats and Independents to view insurance companies as most suited to address health care costs, for both insurance premiums and out-of-pocket costs.

Discussion

Americans across the political spectrum are united in their struggle to afford the cost of health insurance and health care. Medical cost trends projected for 2027 are the highest in nearly two decades and employers are responding by shifting more costs onto workers — through higher cost sharing, tighter utilization management, reduced benefits like prescription drugs, and narrower provider networks. At the same time, policy changes enacted by the Trump administration and Republicans in Congress have helped drive up premiums in the Affordable Care Act marketplace by more than 20 percent in 2026. As a result of these changes, health insurance enrollment is down and insurers are requesting a double-digit increase in premiums, likely because they suspect healthier people are leaving the marketplace, leaving sicker and costlier enrollees. These trends will continue to make health care even more unaffordable for Americans.

Many look to the federal government to solve this affordability crisis, but the current administration’s policies are doing the opposite. The expiration of enhanced premium tax credits, burdensome marketplace eligibility and enrollment rules, and plans with higher out-of-pocket costs are driving down enrollment in the marketplaces. As a result, millions more Americans are projected to become uninsured or underinsured and will struggle to afford timely care. The federal government could instead respond to Americans’ concerns by permanently extending the enhanced marketplace subsidies that expired in 2026, increasing marketplace cost-sharing subsidies, limiting or eliminating deductibles in private plans, removing barriers to eligibility and enrollment in the marketplaces and Medicaid, and meaningfully addressing the root drivers of health care costs, such as provider prices, rather than shifting more and more costs onto patients and their families.

How We Conducted This Survey

The Commonwealth Fund conducted a national, probability-based survey with the SSRS Opinion Panel Mega-Omnibus from May 4 through May 26, 2026, among a sample of 25,873 respondents age 18 and older in the United States. This blog post focuses on 25,858 respondents age 19 and older.

The survey was conducted in English (n=25,422) and Spanish (n=451) via telephone (n=998) and web (24,875) modes. This survey was conducted via the SSRS Opinion Panel, which recruits panelists using probability-based sampling frames, including address-based and prepaid cell phone sample.

Statistical results were weighted to compensate for sample designs and patterns of nonresponse that might bias results. The survey has an overall maximum margin of sampling error for total respondents of +/– 0.8 percentage points at the 95 percent confidence level. The survey completion rate was 55.1 percent.

The authors thank Rob Manley, Elizabeth Sciupac, and Robyn Rapoport of SSRS and Deborah Lorber, Jen Wilson, and Paul Frame of the Commonwealth Fund.