Rising Cost Desperation: Healthcare’s Financial Crisis for American Consumers
In today’s healthcare landscape, a growing demographic termed “Cost Desperate Americans” illuminates the profound financial strain and anxiety experienced by healthcare consumers across the United States. This phenomenon reflects broader systemic challenges that healthcare organizations must address through improved access, communication, and service delivery methods.
The Financial Reality of Healthcare Access
The financial burden of healthcare has created a distinct segment of consumers who delay or avoid necessary care due to cost concerns. As of early 2025, around 35% of Americans (about 91 million people) reported that they couldn’t access quality, affordable healthcare*. This is a four-point increase from 2023 and the highest level since 2021. The crisis disproportionately affects lower-income households and:
- 64% of households earning under $24,000 annually report difficulty accessing affordable healthcare (an 11-point increase)
- 57% of households earning $24,000-$48,000 face similar challenges (a 12-point increase)
- 52% of Hispanic adults report limitations affording and accessing care
- 46% of Black adults report that they couldn’t afford quality care
According to West Health and Gallup research, 12% of U.S. adults borrowed money to pay for healthcare last year, amounting to an estimated $74 billion in healthcare debt. Nearly 60% report feeling “somewhat” or “very” concerned about potential debt from major medical events.
The Digital Divide in Healthcare Portals
Despite significant investment in digital transformation initiatives, healthcare portals remain underutilized by a substantial portion of the population. Research published in Health Affairs reveals that 63% of insured adults who made healthcare visits had not used a portal in the preceding year. This digital divide disproportionately affects lower-income individuals and vulnerable populations.
The study paints a clear demographic profile of portal non-users:
- More likely to be male seniors without a college degree or job
- More likely to reside in rural areas
- More likely to receive Medicaid
- Less likely to have a regular source of care
Notably, men, members of racial or ethnic minority groups, and Medicaid recipients were among those less likely to be offered portal access in the first place, creating a cycle of digital exclusion.
Patients cite multiple reasons for avoiding portals:
- 70% prefer speaking directly with physicians
- 57% see no need to use the portal
- 32% report no online medical record
- 25% lack internet access
- 22% have privacy concerns
For lower-income Americans, these barriers are often multiplied. With 38 million Americans living in poverty and over 40% lacking computer access, digital-only approaches to healthcare communication inadvertently prioritize more privileged individuals while creating additional obstacles for those most in need. These figures highlight significant barriers and demonstrate that many Americans are forced to delay or forgo necessary medical care because of the cost — leading to poor health outcomes.
Voice Channel as a Critical Lifeline for Vulnerable Populations
Despite billions invested in digital transformation, data shows that 82% of interactions with health systems still occur by phone, with 72% of consumers preferring to call when seeking prompt customer service. For lower-income and at-risk populations, the phone represents not merely a preference but a critical lifeline to healthcare access.
Consider these compelling facts:
- While 40% of impoverished adults lack computer access, only 1% lack phones
- 30 million Americans have limited English proficiency, making voice communication more accessible than text-based systems
- 21% of Americans suffer from osteoarthritis, making digital interaction physically challenging
- 21% of Americans are functionally illiterate, severely limiting their ability to navigate complex digital systems
For many low-income individuals, the frustration of navigating outdated phone systems or enduring long hold times adds yet another layer of difficulty to an already stressful healthcare experience.
Modernizing Voice Communication: A Path to Equity
Improving the voice channel represents a strategic opportunity to enhance healthcare access specifically for lower-income and at-risk populations without adding to their burdens. By implementing conversational AI technology, patients can easily navigate healthcare systems by speaking naturally to an AI voice agent.
Hospitals and clinics can:
- Reduce barriers for vulnerable populations: Enable those without digital literacy or the ability to use a computer, to navigate healthcare systems efficiently
- Decrease frustration and effort: Eliminate long hold times and complex menu systems that disproportionately burden those with limited time and resources
- Free human agents for complex cases: Allow staff to focus on patients with urgent needs or complex situations
- Improve appointment adherence: Make scheduling and rescheduling more accessible, reducing no-shows and improving continuity of care
- Lower administrative costs: Achieve operational efficiencies that help contain overall healthcare costs
Modernizing the voice channel acknowledges the reality that for many Americans — particularly those with lower incomes — speaking remains the most natural, accessible, and least burdensome form of healthcare communication. Rather than forcing vulnerable populations to adapt to digital-only systems that many cannot or will not use, enhancing voice communication meets patients where they are.
Conclusion
As financial pressures on American healthcare consumers continue to intensify, healthcare organizations face a critical choice. They can continue pursuing digital-only strategies that inadvertently discriminate against vulnerable populations, or they can embrace comprehensive communication approaches that include modernizing the voice channel.
By acknowledging that many Americans — particularly those with lower incomes — will not or cannot use digital portals, and by investing in voice AI improvements that reduce strain and frustration for these populations and the agents who serve them, health systems can take real steps toward addressing the cost desperation crisis. This approach recognizes that true healthcare transformation must prioritize accessibility for all patients, especially those facing the greatest barriers to care.
*West Health-Gallup Healthcare Affordability Index
By Ali Karasic
