Uninsured Adults With Multiple Conditions Struggle the Most to Afford and Access Care
Adults with multiple or complex health conditions, who already face unique physical and mental challenges, commonly struggle to pay their medical bills and access needed care and medication—challenges that fall hardest on uninsured adults, according to a new KFF survey of more than 25 thousand adults. A companion Beyond the Data column by KFF Founding President and CEO Dr. Drew Altman explores the survey’s findings about uninsured adults with greater health needs and considers why the national discussion of the affordability crisis has largely ignored this group.
“If the first obligation of a health care system is to take care of the sick, we are failing that test. Cost and access problems are hitting the chronically ill hard, and the chronically ill and uninsured especially hard,” said Dr. Drew Altman.
The survey’s large sample size allowed KFF analysts to examine the experiences of adults with certain serious health conditions—including cancer, lung disease, diabetes, cardiovascular disease, or a mental health condition—as well as those managing care for multiple health problems.
About a third of adults ages 18-64 with multiple or certain complex health conditions say they struggled to pay or could not pay their medical bills in the past year. Adults with three or more conditions (36%), those with cardiovascular disease (37%), and those with a mental health condition (36%) are particularly likely to report struggling with medical bills. As part of these affordability challenges, about a quarter of adults with three or more conditions say they have had to cut back on household expenses to cover medical costs, compared to just about 1 in 10 of those without active health conditions.
High health costs can create major barriers to care, sometimes determining who is able to access the treatments and medications they need. About half of adults with three or more health conditions say they skipped or delayed care in the past year, including about 1 in 3 who did so due to cost. About 1 in 5 or more adults with multiple or complex health conditions also report not taking their medications as prescribed because they could not afford the cost.
Skipping or delaying care can have serious consequences. Substantial shares of adults across health conditions say their health got worse because they skipped or delayed care, including about 3 in 10 of those with a mental health condition (32%) or lung disease (29%), one quarter of those with cardiovascular disease (24%), and about 1 in 5 of those with cancer (18%) or diabetes (21%).
In addition to challenges with costs, insured adults with greater health needs commonly encounter insurance coverage delays or denials—problems that occur across specific health conditions. About half of insured adults ages 18-64 with three or more conditions say their insurer denied or delayed coverage for a service, treatment, or medication their doctor prescribed, as do about 4 in 10 or more insured adults with certain complex conditions, including diabetes (38%), lung disease (43%), cancer (43%), cardiovascular disease (45%), or a mental health condition (47%).
Uninsured Adults Struggle the Most to Afford and Access Care
As Drew Altman writes in his new column, health care affordability is most challenging for uninsured adults with multiple health conditions—most of whom say they struggle with medical bills (72%) and half of whom say they cut back on household spending to cover their health costs. Uninsured adults with three or more health conditions are twenty percentage points more likely than their insured counterparts to say they skipped or delayed needed care in the past year (71% vs. 51%). They are also about twice as likely as those who are insured to say they did not take their medication as prescribed due to cost (51% vs. 24%).
For uninsured adults, going without needed care and medications may carry even greater risks that worsen existing barriers to care. Untreated health conditions can worsen over time and become more difficult and costly to treat. Among uninsured adults, about 4 in 10 with multiple conditions (43%) and about half with a mental health condition (47%) say their health got worse after skipping or delaying care—making them about one and a half times as likely as their insured counterparts to experience a decline in health.
Other findings about older adults (aged 65+) with multiple and complex health conditions are available in the full report.
Dr. Altman will discuss KFF’s findings about chronic health conditions and the broader health policy landscape in his keynote address at the National Academy of Medicine’s Annual Meeting in October.
Designed and analyzed by KFF public opinion researchers, KFF’s Survey of Health Access and Caregiving was conducted in English and in Spanish May 4 – 26, 2026, online and by telephone among a large, nationally representative sample of 25,873 adults, including 16,677 who say they have received treatment for at least one serious or complex health condition in the past year. The margin of sampling error is plus or minus one percentage point for the full sample. For results based on other subgroups, the margin of sampling error may be higher.
Facts Only
* KFF conducted a survey of 25,873 adults.
* The survey took place between May 4 and May 26, 2026.
* 16,677 participants reported treatment for at least one serious or complex health condition in the past year.
* Approximately 36% of adults with three or more conditions struggle to pay medical bills.
* About 25% of adults with three or more conditions cut household expenses to cover medical costs.
* Roughly 50% of adults with three or more conditions skipped or delayed care in the past year.
* 20% or more of adults with multiple complex conditions did not take medications as prescribed due to cost.
* 72% of uninsured adults with multiple conditions struggle with medical bills.
* 71% of uninsured adults with three or more conditions skipped or delayed care, compared to 51% of insured adults.
* 51% of uninsured adults with three or more conditions missed medications due to cost, compared to 24% of insured adults.
* 43% of uninsured adults with multiple conditions reported their health worsened after skipping care.
* Approximately 40% to 47% of insured adults with specific complex conditions reported insurer denials or delays.
Executive Summary
Adults with multiple or complex health conditions face significant financial and systemic barriers to medical care, with the most acute challenges affecting the uninsured. A substantial portion of these individuals struggle to pay medical bills, leading many to reduce household spending or skip necessary treatments and medications. These delays in care frequently result in worsening health outcomes, particularly for those managing mental health conditions and lung disease.
Even for those with insurance, the system presents obstacles through coverage denials or delays for prescribed treatments. The disparity in access is most stark among the uninsured with three or more conditions, who are significantly more likely to delay care and experience health declines compared to their insured counterparts. This dynamic creates a cycle where untreated conditions become more difficult and costly to manage over time.
Full Take
This data represents a strong case for the "medical poverty trap," where the cost of managing chronic illness creates a recursive loop of financial instability and physical decline. The strongest version of this narrative is that the U.S. healthcare system fails its most vulnerable population—the chronically ill uninsured—by allowing preventable health deterioration to occur due to cost, which ultimately increases the long-term systemic burden.
The narrative operates on an unstated paradigm: that healthcare is a primary obligation of the state or system ("the first obligation... is to take care of the sick"). It frames the crisis not as a series of individual failures, but as a systemic collapse. This echoes historical patterns of "inverse care," where those with the greatest need for medical care have the least access to it. The second-order consequence is a loss of human dignity; when an individual must choose between household essentials and life-sustaining medication, agency is replaced by survival instinct.
Patterns detected: none
The root cause is the decoupling of medical necessity from financial accessibility. To understand the full scope, one must ask: How do these costs vary across different insurance tiers (e.g., high-deductible plans vs. comprehensive)? To what extent do these delays in care increase emergency room utilization and public cost? What role does the pricing of pharmaceuticals play relative to the cost of clinical services in these struggles?
A coordinated influence campaign using this data would likely employ "Fear Appeal" and "Moral Panic" by highlighting the most extreme individual tragedies to demand specific legislative mandates or product adoptions. The current presentation avoids this, relying instead on broad statistical aggregates and professional commentary.
Counterstrike scan: Clean.