Nearly half the country (44%), or about 114 million Americans, give poor (30%) or failing (14%) grades to the U.S. healthcare system, percentages that climb higher and grow even more negative when it comes to affordability and health equity, according to a new report..

High marks were in short supply across the board, with the healthcare system getting an average grade of C-minus. Women and Hispanic and Asian Americans were more negative, with about half of each group assigning it a grade of D or F compared to about 40% of males, and 43% of White and Black Americans.

After years of higher prices, growing inequities, skipping treatments, getting sicker, or borrowing money to pay medical bills, it’s no wonder so many Americans view the health system so poorly,”“This new report should send a strong message to policymakers that despite the healthcare provisions in the Inflation Reduction Act, most of which will not take effect for some time, there is still immediate work to be done to lower healthcare prices.”

Millions of Americans struggle every day in the face of a high-cost healthcare system, a struggle that not only results in a bad report card but in negative real-life consequences. Nearly one in five Americans say they or a family member had a health problem worsen after being unable to pay for needed care and an estimated 70 million people (27%) report that if they needed quality care today, they would not be able to afford it.

“What I’ve done instead is ration healthcare…medicine. Using less to make it last. Using less than was prescribed in order to make it last longer…Things weren’t as good as they could have been if I’d been using it…the way I should have been,” said 71-year-old Anne Courtney Davis from Ohio, one of the survey respondents.

Additional Key Findings

66% of Americans say their household pays too much relative to the quality of care that it receives, up six points compared to April of last year.

Half the country, about 129 million people, lack confidence they will be able to afford healthcare as they age.

Two in three Americans under 65 are worried Medicare will not exist when they turn 65, and 3 in 4 adults 62 or younger say the same about Social Security.

17% cut back on healthcare services to pay for other household goods with women more likely to do so than men (about 50% more likely); and Black (23%) and Hispanic (24%) Americans 53% and 60% more likely than White adults (15%).

Six in 10 Americans report that cost is an extremely important or important factor when considering a recommended medical procedure or medication.

People 50 to 64 are nearly twice as likely to say cost is extremely important as those over 65 (29% vs. 16%) — rates that run even higher for Black (39%) and Hispanic adults (41%).

“While America’s grading of the U.S. healthcare system is troubling, it provides a roadmap for healthcare systems and policymakers to invest and fix areas with the greatest impact to shift sentiment,”

“What we must remember is that there are actual people behind these grades and that too many Americans are persistently struggling to access and afford quality healthcare.”