Healthcare Is Unaffordable. Here's What CFOs Can Do

One in three Americans don't seek needed healthcare due to costs.

Healthcare is unaffordable. Shocking, right?

A recent report found that roughly 12% of U.S. adults (about 31 million) say they collectively borrowed an estimated $74 billion last year to pay for healthcare, either for themselves or a family member. Additionally, a majority of Americans, about 58%, say they are concerned they would experience medical debt if faced with any major health event.

The research, from a Gallup poll and the West Health Gallup Healthcare Affordability Index, finds that two groups are fueling this increase in medical debt. The percentage of adults aged 50 to 64 who can afford care dropped from 63% to 55%, while the number of adults 65 and older who can afford to pay for their care dropped from 79% to 71%, bringing the total percentage of Americans able to afford healthcare down to 55%, a new low and a six-point decline since 2022.                                                                                                                                                                                      

The study shows that about one in three Americans (about 72 million) don't seek needed healthcare due to costs. This includes  an estimated 8.1 million Americans age 65 and older.

Further, almost one-third of Americans expressed concern about their ability to pay for needed prescriptions over the next year, jumping from 25% in 2022.

This research says a lot. Healthcare is generally unaffordable to many Americans but older Americans are the hardest hit. This, coupled with threats of Medicare and Medicaid cuts, paints a grim picture for public health. Americans owe at least $220 billion in medical debt, according to a KFF study.

The Health System Sponge

At the HealthLeaders 2025 Revenue Cycle Exchange, many executives expressed frustration with medical debt. When patients can't pay, and in light of new policies that take medical debt out of credit scores, providers take on the risk. It's not uncommon for health systems to wipe out medical debt instead of deploying more dollars to chase down these outstanding bills.

"Margins are getting thinner and thinner for hospitals as costs continue to rise," said Elena Barberwis, VP of Finance for both Trinity Health Holy Cross Health and St. Mary's Health Care System. "Prices continue to rise on drug costs. Things are not getting any cheaper, especially with inflation."

The CFO Playbook

CFOs are charged with doing everything they can to lower costs of care within their health systems. And yet, healthcare is still generally unaffordable for so many.

Healthcare needs more effective strategies, developed by both payers and providers.

The Payer's Part

A study from the National Association of Insurance Commissioners found that payer net income actually decreased 14%, from just over $18 billion to approximately $16 billion, for the first six months of 2024 compared to the same period last year. Despite that decrease, the health insurance industry recorded a 17% ($1 billion) increase in net investment income earned.

CFOs will need to work hard to ensure that when they enter a contract with a payer, the risk is more equalized. By pushing back on hardball payer tactics, CFOs can work toward care models that don't let the organization drown in losses when patients can't afford care in an unequal system.

Some strategies CFOs can use when working with payers:

Apply pressure: Don't accept poor performance for inadequate rates

Drive the narrative: Reinforce the need for partnership, patient care over profits

Communicate: Educate leaders, patients, referring physicians on challenges.

No Delegating: Payers try to siphon off leadership tasks to minimize their input. Don't let that happen.

Stay the course: Be patient

Review deliverables: Hold payers accountable. No two negotiations are the same.

Consider creating a national payer scorecard: Keep track of the reputations, strategies and tactics of every payer your organization does business with.

Reaching for Reform

This issue doesn't end with payers and better contracts. Healthcare executives need to recognize that reform must come from all departments.

CFOs should recognize their potential in the fight for healthcare reform. Cuts to Medicare and Medicaid would wreak havoc on an already struggling healthcare system. By using their position and voice to advocate for regulatory reform, CFOs can help drive the changes they want — and need — to see for their organizations. Without this vital tactic, reform for health systems finances will be slowed, and the possibility of it could disappear altogether.