Healthcare Reclaims Top Spot Among U.S. Domestic Worries
61% of Americans worry a great deal about healthcare access and affordability
Average national concern across 16 issues has declined from a year ago
Republicans’ average worry has plunged now that Trump is in his second year
WASHINGTON, D.C. — As the Iran war intensified in March, the latest Gallup poll found healthcare topping Americans’ list of domestic concerns, with more saying they worry “a great deal” about it (61%) than about 15 other domestic policy areas. This was followed by four economic matters of high concern to about half of adults: the economy, inflation, federal spending and the budget deficit, and the way income and wealth are distributed.
Americans were least likely to be concerned about race relations, illegal immigration, unemployment, and the availability and affordability of energy. Roughly a third said they worry a great deal about each of these.
Hunger and homelessness, environmental quality, and the size and power of the federal government round out the top half of the list of 16 items rated this year. Social Security, at 43% high concern, matches this year's average level across the list. Terrorism, crime and violence, and drug use are among the lower-ranked concerns.
With sizable proportions worrying "a fair amount" about each of the 16 issues, all are significant concerns to at least the slight majority of Americans.
National Concerns Have Eased From 2025
Americans’ concerns about national issues have generally declined from a year ago. The average share worried a great deal across the 16 issues fell to 43% this year, down from 46% in March 2025. This is the lowest average concern Gallup has found since 2020, just as the COVID-19 pandemic was starting, when the average reached a record low of 38% in the trend originating in 2001.
The biggest year-over-year declines in elevated worry about specific issues are for the Social Security system and the economy, each down nine percentage points from 2025. The percentages worried a great deal about each of these had surged at the start of President Donald Trump’s second term, but are now back to 2024 levels. Those earlier spikes largely reflected sharp increases in Democratic concern as the new administration took office, even as heightened Republican concern about the issues under the Biden administration had not fully abated.
Meaningful drops this year in Americans’ concern about crime (-8 points) and immigration (-7) largely reflect reduced worry among Republicans, and bring these figures to their lowest levels since at least 2020.
The six-point decline in those worried a great deal about inflation, also owing to Republicans, results in 50% worried. That is the lowest recorded since Gallup began tracking worry about inflation in 2022. It was added to the list that year as high inflation pushed the issue back onto the national agenda after several decades of dormancy.
There has been no significant increase in worry about any issue over the past year. Rather, the percentages highly worried about the remaining 11 items on this year's list, including healthcare, are generally unchanged.
Healthcare's current position represents a return to its prominence in prior decades. It ranked as the top concern from 2015 to 2020, before being displaced during the Biden presidency by other issues, especially the economy and inflation. Before that, from 2002 to 2014, the economy and healthcare had either tied or traded places as the leading concern. While healthcare roughly tied the economy as Americans' top concern in 2025, it now leads by a full 10 points.
As Gallup has reported separately, the steadiness in Americans’ concern about the availability and affordability of energy compared with a year ago is notable, given the disruption to the global energy-supply network that was unfolding at the time of the poll.
Republicans Focus on Immigration; Democrats, on Healthcare
Republicans and Democrats worry about sharply different things, with illegal immigration the chief concern of Republicans, at 55%, followed by federal spending and the budget deficit (47%), drug use (42%), and crime and violence (41%). By contrast, Democrats’ top concerns are healthcare (80%), income/wealth distribution (77%) and the economy (69%).
Meanwhile, independents’ top concerns (healthcare, inflation, federal spending and the economy) overlap with both partisan groups, although more with Democrats.
The sharpest partisan divides are seen on income and wealth distribution, where Democrats’ concern (77%) leads Republicans’ (19%) by 58 points. There is a 52-point difference on the environment (67% Democratic vs. 15% Republican). Illegal immigration is the one issue where Republicans’ concern (55%) far outweighs Democrats’ (17%), a 38-point difference.
Flip in Partisan Ratings Under Trump Is Complete
Republicans’ average concern across all issues measured has fallen considerably over the past three years — from 53% during President Joe Biden's final year in office to 42% in 2025, after Trump had been in office a month and a half, to 30% now. Meanwhile, Democrats' average concern, at 51%, remains elevated and similar to the 52% measured last year, but up substantially from 37% in Biden’s last year in office.
These patterns mirror those seen in Gallup’s historical data, whereby supporters of the party out of power worry more about the issues, and supporters of the president’s party worry less.
Democrats’ current average concern is slightly higher than the 47% to 49% levels recorded during Trump’s first term, and is equivalent to the highest readings of George W. Bush’s presidency. Republicans’ average concern is lower than that seen in the initial years of Trump’s first term but not as low as in 2020. Meanwhile, at 46%, independents’ current average concern is consistent with the relatively high level seen for that group over the past five years, since 2022.
Bottom Line
Healthcare has reclaimed its position as Americans' foremost domestic concern, returning to the top tier after several years when economic matters commanded more attention. While the percentage highly worried about the availability and affordability of healthcare hasn’t increased over the past year, ongoing public concerns about healthcare costs, including personal challenges in affording care, make this a perennial concern.
Overall, Americans’ anxiety about national issues has eased to its lowest level since the eve of the COVID-19 pandemic, driven largely by declining Republican concern, as the issues that drove that party’s worry during the Biden years (particularly the economy and inflation) have receded.
Behind the national figures, Republicans’ outlook on national problems has now fully transitioned from a Democratic-control mindset influencing their ratings during Biden’s presidency to a Republican-control mindset, now that Trump has been in office a full year. Democrats had already adopted a Republican-control mindset last year, and they retain those low ratings today.
Since the survey was conducted, the Iran war has escalated and led to further increases in energy costs and potentially to greater public anxiety about its broader effects on prices, employment and national security. Thus, while the figures reported here document how Americans viewed national problems at the start of the war, they may not reflect their feelings today.
Cost Leads Americans' Top-of-Mind Healthcare Concerns
by Lydia Saad and Megan Brenan
Story Highlights
29% cite healthcare cost as most urgent national health problem
16% satisfied with cost of healthcare in U.S.; 57% satisfied with own costs
Record-high 23% say healthcare system in crisis; 47% see major problems
Editor’s Note: This research was conducted in partnership with the West Health-Gallup Center on Healthcare in America, a joint initiative to report the voices and experiences of Americans within the healthcare system.
Americans’ already elevated perception that the cost of healthcare is the “most urgent health problem” facing the country rose further this year to 29%, up from 23% a year ago. The latest figure is the highest level recorded since 2004 and also one of the highest readings in the trend dating back to 1987. Cost now outpaces access to healthcare, at 17%, and obesity, at 8%, as what Americans consider to be the nation’s top health problem.
These findings are from the West Health-Gallup Health and Healthcare Survey, conducted Nov. 3-25. Cost and access have typically topped the list of health problems in the U.S. since 2000, although they were displaced during the pandemic in 2020 and 2021, as people were mainly concerned about COVID-19. But as that focus lessened, concerns about cost and access returned.
Today’s 29% of Americans mentioning healthcare costs exceeds the 16% to 27% range seen in the five years before the pandemic and is one percentage point shy of the record-high 30% measured in 1992. Twenty-nine percent also cited cost as the most urgent health problem in 2004.
While up from 2020, mentions of access to healthcare remain below the 22% recorded in the last pre-pandemic measure in 2018 and the record highs of 29% in 2007 and 2008.
After obesity, the specific medical issues most often cited as the nation’s top health problem are cancer and mental illness, both at 4%. Mentions of cancer are down sharply from the 10% seen before the pandemic. On the other hand, mentions of mental illness, which peaked at 7% as a concern in 2023, remain higher than the pre-pandemic rates that were mostly below 3%.
Record-Low 16% Satisfied With Cost of U.S. Healthcare
Low satisfaction with U.S. healthcare costs is another indication of the public’s sharpened concern about affordability. Satisfaction with U.S. healthcare costs is the lowest Gallup has recorded in annual trends since 2001, as 16% now say they are satisfied, compared with 19% a year ago and an all-time high of 30% in the first year of the pandemic.
Meanwhile, U.S. adults’ satisfaction with their own healthcare costs remains steady at 57%, similar to where it’s been since 2022. This too was elevated during the pandemic, but the current level is similar to the rate seen for most of the two decades leading up to 2020.
A similar picture is seen in the public’s ratings of healthcare coverage, with a strong majority rating their own healthcare coverage positively, while a reduced minority say the same of healthcare coverage nationally.
Currently, 65% of Americans say their own healthcare coverage is excellent or good, just slightly below the average of 68% since 2001. At the same time, 24% rate healthcare coverage nationally this positively, down from last year’s 28% and the average of 32% across the trend. Today’s positive rating of U.S. healthcare coverage is the lowest Gallup has recorded in two decades.
Record-High 23% Say U.S. Healthcare System ‘in State of Crisis’
Americans’ elevated concern about the nation’s healthcare costs combined with their lower evaluation of coverage may be contributing to a record-high 23% now saying the U.S. healthcare system is “in a state of crisis” and another 47% saying the system has “major problems.” Fewer U.S. adults, 26%, describe the problems as “minor,” and just 3% believe the healthcare system is free of problems.
The current findings are a continuation of the pattern seen since 1994, whereby in most years, pluralities or majorities of Americans have said the nation’s healthcare system has major problems. However, the 23% describing the system as being in crisis is the highest in Gallup’s trend to date, by two points over 2009 and 2013 readings. Compared with last year, more say the system is in crisis (up seven points) and fewer say it has major problems (down seven points).
Between 2001 and 2011, spanning both George W. Bush’s presidency and the start of Barack Obama’s, Democrats were the most likely to say the healthcare system had major problems or worse. However, since the passage of the Affordable Care Act in 2010, partisans’ views of the healthcare system have been more sensitive to the party in power. That is, Republicans and Democrats have generally offered better assessments of the healthcare system when the sitting president’s party has matched their own.
The 81% of Democrats who now say healthcare is in a state of crisis or has major problems is up 10 points since last year and is similar to the group’s 84% record high in 2018, during Donald Trump’s first term. Meanwhile, Republicans’ negative assessment of the healthcare system (64%) has dropped seven points since last year, when Joe Biden was in office. Throughout the trend, independents’ views have generally been similar to those of U.S. adults overall.
Nearly Two-Thirds Say Government Should Ensure All Have Coverage
When it comes to the public’s preference for government involvement in the healthcare system, 64% of U.S. adults believe it is the federal government’s responsibility to ensure that all Americans have healthcare coverage. This is the highest percentage since 2007 calling for such government intervention, although the reading has been consistently at the majority level over the past decade.
Similarly, from 2000 through 2008, majorities of Americans said it was the government’s responsibility to make sure all Americans had health coverage. However, during the Obama administration, as the ACA was drafted, passed into law and implemented, public support for government intervention in this realm was at or below 50%. The reading slipped to a low of 42% in 2013 during the troubled rollout of the ACA healthcare exchanges. The high point in belief that the government should ensure coverage for all was 69%, recorded in 2006.
Partisans’ views of the federal government’s responsibility to ensure healthcare for all Americans differ sharply, as they have throughout the trend. Currently, 90% of Democrats and 73% of independents, but just 26% of Republicans, think the government is responsible. This 64-point gap between Democrats and Republicans is among the largest in the 25-year trend, while the reading among independents is the highest for the group by two points.
Public Divided Over Private vs. Government-Run Healthcare System
At the same time that a majority of Americans see a government role in ensuring universal U.S. healthcare coverage, they are divided over whether the nation’s healthcare system should be based on private insurance or run by the government. Currently, 48% of U.S. adults prefer a private system, while 46% support a government-run system. This is the second straight year that U.S. adults are divided.
From 2010, when the measure was first tracked, through 2023, majorities of Americans favored private insurance, with just one exception: 2017, when they were evenly divided in preferences.
Democrats’ long-standing majority-level preference for a government-run system persists, as 67% now favor it. This compares with a relatively steady 18% of Republicans and a new high of 51% of independents.
Bottom Line
Americans’ concerns about the U.S. healthcare system persist, with the cost of healthcare as the nation’s top health problem at its highest level in more than two decades. This rise comes ahead of 2026 premium increases for ACA subscribers, absent any last-minute legislative remedy from Congress and the president. This heightened concern is reinforced by record-low satisfaction with the cost of U.S. healthcare and diminished ratings of the nation’s healthcare coverage overall, even as most Americans remain satisfied with their own coverage and personal healthcare costs.
These pressures on affordability and system performance are shaping broader public judgments about the health system. Seven in 10 Americans say the U.S. healthcare system has major problems or worse, including a record-high 23% who believe it is in a state of crisis. Partisan dynamics continue to influence perceptions of system quality.
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Meanwhile, the highest percentage of Americans since 2007 say the government should ensure that all Americans have healthcare coverage. Approval of the Affordable Care Act has reached a new high, suggesting the law’s standing has strengthened as Americans weigh the trade-offs of the current system and concerns about affordability.
Despite rising support for government responsibility, Americans remain closely divided over whether the nation’s healthcare system should rely on private insurance or be run by the government. Together, these findings point to a complex healthcare policy environment — one in which Americans are looking for financial relief while being satisfied with their current coverage and are split along partisan lines over how much to rely on government-backed insurance solutions.
