A survey by Gallup and West Health, conducted between June and August 2025, revealed stark disparities in how United States adults across all 50 states and the District of Columbia experience healthcare. The results exposed persistent barriers in cost, quality, and access that shape daily medical realities nationwide.
State-by-State Assessment of American Healthcare: 2025 Gallup and West Health Survey Revealed How Americans Experience Healthcare in Their States
Gallup and West Health mapped the realities of U.S. healthcare in 2025 and uncovered widespread affordability fears, delayed treatments, and uneven provider access. State-level geography significantly determines how easily residents receive timely, effective, and financially manageable care.
Background
The study was conducted collaboratively by West Health and Gallup under the newly established West Health-Gallup Center for Healthcare in America. Its purpose was to examine how Americans experience healthcare in practical terms and move beyond policy debates and political discourse to understand perceptions and tangible obstacles in daily life.
Note that the researchers initially included more than 40 survey questions covering cost, quality, and access dimensions. Factor analysis reduced the items to 27 survey questions to reflect high internal consistency across cost, quality, and access. This is intended to guarantee dependable measurement of healthcare experiences across populations.
About 20000 U.S. adults aged 18 and older participated in the survey. The sample represented diverse demographic, socioeconomic, and geographic groups. Data allowed comparisons across all 50 states and Washington, D.C. to offer insights into state-level disparities, while highlighting top-performing and underperforming states on multiple dimensions.
Main Findings
The study revealed widespread concerns among Americans regarding the affordability, accessibility, and quality of healthcare. Residents in all states expressed financial stress, delayed care, and difficulties navigating the healthcare system. State-level differences highlighted disparities, with some regions outperforming others across all measured dimensions.
• Affordability Concerns
47 percent of adults reported worry about affording necessary care in the coming year. 20 percent indicated household members were unable to pay for prescription medications within the past 3 months. This shows financial barriers affecting health outcomes.
• Skipping or Delaying Care
30 percent of respondents stated they or a household member skipped medical treatment due to cost constraints, demonstrating that financial limitations translate into tangible disruptions in healthcare utilization and adherence to recommended treatments.
• Perceived Quality of Care
71 percent reported providers ensured completion of all recommended screenings and evaluations. 72 percent indicated providers offered guidance on healthy lifestyle choices. This reflects generally positive perceptions of proactive care delivery.
• Access Challenges
25 percent reported difficulty finding providers. 53 percent cited long appointment wait times as obstacles to receiving timely care. Structural and informational barriers continue to affect healthcare access nationwide and limit necessary services.
• Specific State-Level Variation
Iowa and Massachusetts ranked highest overall with strong performance in cost, quality, and access. Alaska, Arkansas, and Texas consistently underperformed. Geographic location substantially affects the patient experience across the United States.
• Top Versus Bottom States
In top-performing states, 25 percent of reported skipping health care due to cost, compared with 40 percent in bottom-performing states. Prescription affordability challenges were reported by 15 percent in the top states and 29 percent in the bottom state.
• Overall Healthcare Grade
Americans assigned the U.S. healthcare system an overall grade of C. Cost received a D+, while quality and access each earned a C+. No state achieved an A in any category. Even the strongest performers leave substantial room for improvement.
The top-performing states in the Gallup and West Health poll include Iowa and Massachusetts, which ranked highly across cost, quality, and access, alongside Nebraska, North Dakota, and Pennsylvania, each demonstrating comparatively strong healthcare experiences and reduced barriers that contributed to overall positive outcomes for residents statewide.
Moreover, the bottom-performing states in the Gallup and West Health assessment include Alaska, Arkansas, and Texas, each consistently ranking low across cost, quality, and access, along with states such as Oklahoma and Mississippi, where residents reported significant financial strain, limited provider availability, and widespread challenges obtaining timely care.
Implications
The findings underscore that healthcare affordability remains the most urgent challenge for adults in the United States. Rising cost anxiety and the inability to afford essential medications threaten adherence to care, increase health risks, and contribute to financial stress across households. This indicates that policy interventions targeting cost reduction are critical.
Note that state-level variations reveal opportunities for policymakers to learn from top-performing regions. States such as Iowa and Massachusetts illustrate approaches to reducing cost burdens, improving proactive preventive care, and addressing access challenges, thus demonstrating that measurable improvements are possible within existing healthcare structures.
Access challenges, including long wait times and difficulty locating providers, reinforce the need for targeted structural improvements. Addressing these barriers requires investment in provider availability, patient education, and care coordination, ensuring geographic and informational disparities do not prevent Americans from receiving timely and effective care.
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