The American Heart Association released a Presidential Advisory on April 30, 2026, warning that health care affordability in the United States has reached crisis levels. Total health care spending is approaching $5 trillion annually and is projected to consume 20% of the nation's gross domestic product within the next decade, according to the advisory. The organization also projects that health care costs related to cardiovascular disease will quadruple by 2050.

The advisory highlights that rising costs are forcing many people to delay or avoid care altogether, contributing to worsening health outcomes and increasing medical debt. Medical debt, a uniquely American problem among high-income countries, is a leading cause of personal bankruptcy. A survey from political pollster McLaughlin & Associates found that more than half (51%) of voters say health insurance is their top health concern, with hospital bills and the cost of medicines also ranking high.

“Health care affordability is one of the defining challenges of our time,” said Dhruv S. Kazi, M.D., M.S., American Heart Association volunteer and writing committee chair, in a statement. “This advisory outlines core guiding principles for action to ensure everyone in this country has access to the care they need and the health care system is sustainable for generations to come.”

The advisory identifies several interconnected drivers behind rising costs, including high prices for treatments and services, administrative complexity, underinvestment in prevention and public health, demographic shifts, and cost shifting to patients. The Heart Association suggests that affordability cannot be addressed through cuts alone; strategic investments in the health care workforce, infrastructure, primary care, data, and public health are also necessary.

To guide policymakers and stakeholders, the advisory outlines five core principles: access to high-quality care without financial hardship; minimal or no-cost-sharing for high-value, cost-effective care, including preventive services; shared accountability across the health care ecosystem for advancing a more efficient, transparent, and cost-conscious system; strategic investments in the health care workforce, infrastructure, and data; and strengthening the public health infrastructure while addressing health inequities.

“We at the American Heart Association believe everyone deserves access to quality health care without financial hardship,” said Nancy Brown, chief executive officer of the American Heart Association. “Affordability is not just an economic issue – it is a health issue that directly affects lives.”

The advisory was informed by interviews and listening sessions with patients, clinicians, payer representatives, employer representatives, health system leaders, and public health experts. The Heart Association encourages policymakers and health care leaders to use the advisory as a roadmap for meaningful action. The association receives funding primarily from individuals, with foundations and corporations also making donations, and has strict policies to prevent these relationships from influencing science content. More than 8 in 10 U.S. adults say they are confident in the American Heart Association to provide trustworthy information related to public health, according to a recent Annenberg Policy Center poll.

The implications of this advisory are significant. If health care costs continue to rise unchecked, more Americans may face financial hardship and poor health outcomes. The advisory serves as a call to action for systemic changes to ensure a sustainable health care system for future generations.

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