Skipping lunch to save money on prescriptions. Stretching medication doses. Turning down the thermostat and piling on blankets instead of filling a prescription.
These aren't edge cases. According to a new West Health-Gallup survey of nearly 20,000 adults, roughly one-third of Americans have cut back on basic living expenses to cover their health care costs. That's more than 82 million people making daily tradeoffs between medicine and meals, between doctor visits and keeping the lights on.
And the trend lines are moving in the wrong direction. Every metric tracked since 2021 has gotten worse.
It's Not Just the Uninsured
The instinct is to assume this only affects people without coverage. It doesn't.
Nearly four in ten insured adults still report skipping or postponing care because of cost, according to KFF. Having a card in your wallet doesn't mean you can afford to use it. Deductibles are higher. Copays are climbing. Out-of-pocket costs have outpaced general inflation for over two decades.
And it's not just lower-income households feeling the squeeze. The Gallup data shows that roughly half of middle-income families, those earning between $48,000 and $180,000 a year, have delayed a major life decision because of health care costs in the past four years.
People Are Putting Their Lives on Hold
This is where the data stops being abstract.
An estimated 24 million Americans say they've postponed retirement because of health care expenses. Twice as many have delayed changing jobs. Fourteen percent have put off buying a home. Six percent have postponed having a child.
Read that again. People are delaying families, careers, and retirement not because they can't find opportunities, but because they can't afford to lose their health coverage.
That's not a health care problem. That's an economic anchor dragging on the entire workforce.
The Coverage Gap Nobody Talks About
Here's what makes this especially relevant for employers: many of these decisions cluster around workforce transitions.
When someone leaves a job, voluntarily or not, the default path is COBRA. It's familiar. It's compliant. And for most people, it's wildly expensive. COBRA premiums can run 102% of the full plan cost, with no employer subsidy to soften the blow.
Meanwhile, marketplace plans, spousal coverage, and Medicare (for those who qualify) often provide comparable or better coverage at a fraction of the price. But departing employees rarely explore those options because nobody points them in that direction.
So they elect COBRA by default. Or they go without coverage entirely. And the cycle of rationing, skipping care, and financial stress continues.
What Employers Can Actually Do About It
You can't fix the U.S. health care system from your benefits office. But you can fix the moment that matters most: the transition.
When employees leave your organization, the coverage decision they make in those first few weeks has an outsized impact on their financial health for months, sometimes years. Most of them have no idea that better, more affordable options exist.
That's the gap When was built to close.
When's platform guides departing employees through a personalized comparison of every coverage option available to them, including COBRA, ACA marketplace plans, Medicare, and spousal coverage. Licensed agents help with enrollment. And employees walk away with a plan that actually fits their situation, not just the one that showed up in their separation packet.
The result: employees save 40 to 60% compared to COBRA costs. Employers reduce high-cost claims exposure. And people stop making impossible choices between their health and their bills.
The Stakes Are Only Getting Higher
ACA premium subsidies expired at the end of last year. Millions more Americans are expected to lose coverage in the months ahead. The pressure on working families is not easing up.
For employers, this is a moment to lead. Not with more paperwork. Not with a thicker COBRA packet. But with real guidance that helps people land on their feet.
Because when 82 million Americans are rationing medicine, the companies that actually help their people through transitions won't just reduce costs. They'll stand out.
