On this much Democrats and Republicans agree: The cost of health insurance and health care are the biggest problems in health care today.

A new survey said more than 4 in 10 adults cited the cost of health insurance as the biggest problem that needs to be fixed in the U.S. health care system. That sentiment was consistent across political affiliation, with 45% of Republicans, 44% of Democrats and 42% of independents naming health insurance as their top concern, according to the Commonwealth Fund survey of more than 25,000 adults.

But many people also worried about the amount they spend on co-pays and deductibles for health expenses such as medical bills, lab tests or prescription drugs. About 36% of adults cited these out-of-pocket costs as their second biggest worry with the U.S. health care system.

People were less stressed about insurer “prior authorizations,” which make consumers and doctors get insurance company approval before billing for health care services or prescriptions.

Millions of Americans who get Affordable Care Act health insurance this year are paying substantially more for health insurance premiums, and the survey shows consumers who get this type of insurance are anxious about their ability to pay for coverage to get needed medical care.

“Across the political spectrum, people are dealing with the cost of their insurance,” said Sara Collins, Commonwealth Fund’s senior scholar for expanding coverage and access and tracking health system performance. “It’s part of this larger issue of affordability in all aspects of people’s lives.”

Millions drop ACA plans as subsidies expire

More than 3 million ACA enrollees dropped their coverage as of February amid higher monthly premiums and the expiration of enhanced subsidies that made the health insurance more affordable. When Congress didn’t extend the enhanced subsidies that expired at the end of 2025, average costs for ACA enrollees who wanted to keep their insurance plans soared 114% in 2026, according to KFF, a health policy nonprofit.

More than half of survey participants who bought ACA plans or other coverage directly from insurance companies cited cost as their biggest worry, the survey said.

“If people aren’t able to afford their (ACA) premiums, and we’re already seeing evidence of that, they’re going to become uninsured,” Collins said.

Most working-age adults and families get insurance through the workplace, and those costs are rising, too. Companies expect insurance costs for their employees will rise nearly 7% in 2026. That means insurance benefits will cost about $18,500 per employee in 2026, according to consultant Mercer.

The Commonwealth Fund survey said about 44% of adults who get their insurance through the workplace cited the cost of those plans as their top concern. Employers typically pick up most of the cost of health insurance, but workers must pay a portion of the tab, usually through paycheck deductions.

More cuts are on the way under a provision of Republicans’ 2025 budget bill that would make millions of Medicaid recipients work, complete job training or volunteer to maintain government-funded health insurance. As many as 18.5 million people must meet the work requirement to maintain coverage, and the Congressional Budget Office projects that more than 5 million will lose their Medicaid coverage by 2034.

Who can fix health affordability – government or insurance companies?

While both Republicans and Democrats largely agree that heath care is driving up the cost of living, they differ on the prescription to fix these expenses.

The survey said 65% of Democrats cited the federal government as best able to solve the problem of health insurance costs, but 36% of Republicans said government should act on health insurance costs. Republicans were twice as likely as Democrats to say health insurance companies were better able to address insurance premium costs.