Health care that people can afford is an essential aspect of health justice—in which health care is accessible, equitable, and comprehensive.

Given the way the US health system is set up, it is no surprise that people without health insurance have difficulty affording the high costs associated with medical care, oral health, and prescriptions. A broken arm without insurance will put you back about $2,500. A cancer diagnosis can easily cost hundreds of thousands of dollars.

Yet even people with insurance, regardless of what type, often find it difficult to afford the comprehensive care they need.

Currently, about half of adults in the US say they have difficulty affording health care. 

For Black and Hispanic adults, it is dramatically higher—at least six in ten Black adults (60 percent) and Hispanic adults (65 percent) report difficulty affording health care costs compared to about four in ten white adults (39 percent).

But it doesn’t have to be this way. The United States has one of the world’s most expensive health care systems and associated costs, yet some of the worst health outcomes. In a study by The Commonwealth Fund that compares health care across 11 wealthy nations: “The United States ranks last overall, despite spending far more of its gross domestic product on health care. The US ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.”

The high cost of health care makes existing inequities within our health care system even worse.

The complexities and financial burdens of premiums, deductibles, co-insurance, and co-pays all contribute to whether an individual receives, delays, or foregoes care altogether. And communities of color face even more challenges because of structural racism that is embedded into the current health care system.

For example, one study found that dentists’ decisions are affected by unconscious racial bias in which Black patients with tooth decay are more likely than their white peers to receive a tooth extraction—a far more invasive and expensive procedure—instead of a root canal.

Policies that begin to address affordability, such as the Affordable Care Act, have gone a long way in making health care more affordable, but costs are still high.

To make health care truly affordable, we need to think bigger: from reforms that overhaul how health system finance is structured to eliminating unjust and predatory medical debt collection practices, and—ultimately, a system that ensures everyone can access affordable care, regardless of their insurance status.

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