The share of Americans who are secure about their healthcare costs — meaning they can access quality healthcare and afford the medicine and care they need — fell to a five-year low of 49% last year, a new Gallup and West Health poll found.

Forty-one percent are “cost insecure” — meaning either they don’t have access to good, affordable care or were recently unable to pay for care or medicine they needed.

Healthcare costs promise to be a leading issue in the midterm elections, and they’re a challenge for Americans of all income brackets, to some degree; 34% of those living in households making between $120,000 and $179,999 aren’t cost secure.

And while older Americans tend to be covered by Medicare, the share of adults 65 and older who are cost secure still declined from 69% in 2024 to 61% last year.