Three in four Americans name insurance premiums or out-of-pocket costs as the most important problem in US health care. The finding holds regardless of political affiliation, insurance type, or age, according to a new Commonwealth Fund survey.
The survey, conducted by SSRS from May 4 through May 26, drew on responses from 25,858 US adults aged 19 and older. It carries a margin of sampling error of plus or minus 0.8 percentage points at the 95% confidence level.
Forty-two percent of respondents identified high insurance premium costs as the top problem. Another 36 percent named high out-of-pocket costs as the most pressing issue. The combined figure of 78 percent represents the largest cluster of concern across all categories tested, ahead of provider access, care quality, and coverage gaps.
The survey found no meaningful partisan divide on those top concerns. Similar shares of Republicans, Democrats, and Independents selected insurance premiums and out-of-pocket costs as the leading problem. The affordability concern is most concentrated among people with employer-sponsored coverage, individual or marketplace coverage, and the uninsured - more than eight in 10 respondents in each of those groups cited premium or out-of-pocket costs. Among people with Medicare, premiums were still the top concern despite the program's structure.
The survey data sits against a documented cost trajectory. Mercer's 2025 National Survey of Employer-Sponsored Health Plans found that the average cost of employer-sponsored health insurance reached $17,496 per employee in 2025 - a 6% increase that outpaced both inflation and wage growth. Mercer projects the figure will exceed $18,500 per employee in 2026.
Mercer's Survey on Health and Benefit Strategies for 2027, fielded April to May 2026, found that nearly half of large employers expect to make plan design changes raising out-of-pocket costs for employees next year, including higher deductibles and copayments. When employers raise deductibles or narrow formularies, employees absorb the difference at the point of care.
Opinion divides when the survey turns from problem identification to responsibility. Half of all respondents said the federal government is best positioned to address high insurance premium costs. Four in 10 said the same for out-of-pocket costs.
The federal government is the leading choice across party lines, but with variation. Sixty-five percent of Democrats selected it as best able to address health care cost problems. Thirty-six percent of Republicans agreed. Among Independents, 49 percent chose the federal government versus 28 percent who named insurance companies. Republicans were more likely than Democrats or Independents to name insurance companies as best suited to address both premium and out-of-pocket costs. The survey does not ask respondents to specify what actions they would want from either the government or insurance companies.
For benefits brokers, the survey adds public opinion data to a cost picture already documented in employer research. The 78 percent affordability concern among employer-insured respondents describes the pressure employees bring to open enrollment and plan utilization decisions. Mercer's 2025 survey found 51 percent of employers said they were likely or very likely to shift more costs to employees for 2026 plans, up from 45 percent the prior year.
The Commonwealth Fund data captures how those decisions register from the employee side - and it describes a workforce that is already primed to push back. Employers that shift costs to employees without clearly explaining the reasoning behind the change are walking into open enrollment conversations where employees already believe premiums are the top problem in US health care. Brokers who help employers communicate the rationale for plan design changes before open enrollment, rather than presenting them as a fait accompli during it, are positioned to reduce friction in those conversations in a way that a competing quote at renewal cannot replicate.
