healthcare cost

McALLEN, Texas — The Ford Expedition rumbled to a stop and Cindy Banda’s bedazzled flip-flops landed on the asphalt of the Houston cancer center’s vast parking lot. She threaded through the rows of cars, a tally of patients who gather here to sit with chemotherapy needles or lie on radiation machines.

The elevator dinged open. A year ago in this building, surgeons removed Banda’s right breast, and she still didn’t know whether treatment had expunged the cancer from her body. Doctors had told her it would be tough to beat.

“I’m more of a positive person myself,” Banda said, now sitting with a white wristband in a dim waiting room. But the bills are harder to dismiss, and the single mother with six children in her care repeated something like a mantra. “Keep the house. Keep the cars. And just keep the kids stable.”

That’s true for many Americans, as rising healthcare costs leave more families with a sinking feeling after seeing the bill for surgery or medication. Heading into the Nov. 3 midterm elections, about half of registered voters said healthcare costs are a major problem for them and their families, up from a little more than one-third four years ago, according to a Fox News poll from September.

With party control of Congress at stake, registered voters are nearly twice as likely to say they trust Democrats over Republicans to handle healthcare, according to an Associated Press-NORC Center for Public Affairs Research poll from the same month. Those frustrations, combined with broader concerns over rising prices, have sapped support for President Trump and his Republican Party.

Banda knows how that feels. She backed Trump in each of his three campaigns, motivated by her opposition to abortion. But when cancer came, the ensuing scramble to make ends meet was painful enough to rearrange her priorities, and she started to think about voting Democratic for the first time.

The 46-year-old was ushered into a sterile room for her appointment, her phone lighted up with a text. “Please contact TD Auto Finance.”

“This one’s $1,300,” she said of the car payment bill. “I have to go back to work.”

She had been on sick leave for a year from her job selling internet service, and she needed the income to support her three children and three more she had taken in after her sister’s death.

The doctor said her reconstruction surgery could be scheduled early next year. “I was hoping for maybe December,” Banda said, “only because I’ve met my deductibles.” Come January, she would have to pay down the $7,500 again. Earlier may be possible, the doctor replied, if the skin around her surgical scar loosens.

The evening had cooled slightly by the time she walked back through the rows of parked cars, their ebb and flow marking the tide of sickness, survival and death in a small corner of a colossal healthcare industry that saves lives while taking in over $5 trillion every year.

Banda paid $8 for parking as she left.

Confronting death and debt

Two weeks later, Banda was back at work, making door-to-door rounds to sell Spectrum’s Wi-Fi in McAllen, her city along the U.S.-Mexico border in the Rio Grande Valley. Banda, holding blue fliers, walked along a row of storefronts, some that closed since she last was in the area.

She hadn’t had a sale and commission since October of last year, after the biopsy and diagnosis.

The doctor who gave her the news had hugged Banda, and she sobbed even though, she says, she never really sobs in front of other people. During chemo, her children took turns buzzing off her wispy hair. When her 9-year-old daughter’s hand quivered, a teenage cousin helped guide the clipper over her mother’s scalp.

Banda’s first impulse was to maintain normality, stability, for the children.

But that requires roughly $7,000 a month for utilities, mortgage, car payments and groceries, along with the two water leaks. Then, even with insurance through her job, the surgeries, chemo and radiation added up to over $25,000 that she’s been paying off, making Banda one of tens of millions of other people in the United States in medical debt.

Banda tries not to dwell on death and debt.

“It’ll consume you,” she says. She smothers those thoughts beneath her bubbly demeanor and avoids being alone. But that truce, between her insistence on positivity and the fears that it covers, is brittle.

Certain thoughts still arrive uninvited. Banda’s late sister, Melissa, didn’t have life insurance. Banda makes sure it’s a payment she never misses.

“Sometimes I think, and I shouldn’t think like this, but I’m worth more gone than here,” she said one day. “Obviously, the goal is not that, the goal is to beat it,” she continued, “to keep the house and keep the cars.”

So far she has, with the help of others.

On top of child support, the father of Banda’s 9-year-old often pays $400 a week for a nanny to help with the kids. Banda’s own father sent her $700 before for her recent Houston appointment, one of his many cash infusions. Her high school classmates, whom she hadn’t been in close touch with in decades, fundraised by selling grilled chicken, rice and beans from a roadside tent. Two GoFundMe fundraisers collected nearly $30,000, and Banda rented her late sister’s house while putting her own in forbearance.

But months of insecurity takes its own, sleepless toll. She needed to sell some internet services to catch up.

After sticking the Spectrum Wi-Fi fliers onto empty storefronts, she drove to pick up her kids from school. The following day she had a morning meeting at a barbershop for what would be her first sale back at work.

Turning on Trump

A lifelong Christian, Banda had voted her antiabortion stance in past elections. When her sister was kidnapped and murdered by her ex-husband in 2020, Banda retreated from religion. The cancer brought her back to church with an apology to God, but it also made her rethink her politics.

She voted for Trump in 2016, and his first four years seemed steady, she said, so she voted for him again in 2020. President Biden’s tenure, including a global pandemic and related inflation, felt like bedlam, so she voted for Trump to return to the White House in 2024.

But two years later and fighting an expensive disease, she had found no respite from high prices.

So when James Talarico, a Presbyterian seminary student running for U.S. Senate as a Democrat, visited one of Banda’s fundraisers — speaking about his diabetes and his work in the Texas Statehouse to lower the price of insulin — it moved her. “Imagine if he can do that for the cancer,” she said.

Talarico and his Republican opponent, state Atty. Gen. Ken Paxton, have different approaches to healthcare. Talarico wants all Americans to be able to join Medicare; Paxton proposed a $25,000 tax deduction for out-of-pocket medical expenses.

Talarico also supports a law guaranteeing abortion access nationwide, which Banda has voted against for years. But after she slid into debt to stay alive, after her grocery bills mounted and the high school had to comp the kids’ soccer gear she couldn’t afford, Banda’s antiabortion concerns have been superseded by worry about costs.

“Because it’s what I’m living,” she said. “I’m living it.”

Banda cast an early ballot for Talarico. “Never voted Democrat before today!!” she wrote in a text with blue heart emoji.

Awaiting news

Banda had just started a new cancer-targeting medication that cost $16,000 a month, reduced to $500 by insurance. By the afternoon, she was nauseated and fatigued, unable to eat. The malaise would keep her home the next day. She would miss the meeting with the barbershop to close her first deal since getting sick, though she felt confident it was in the bag.

But Banda pushed through the discomfort one evening to join her family as they replaced the flowers at her sister’s tomb.

She drove past the headstones and oak trees in the evening’s slanting light, and the family gathered around Melissa Banda’s tomb in an open-air mausoleum. There was no speech. Their eulogy was her father, Fidel Banda, methodically clipping and arranging the flowers for his daughter.

Banda walked along the wall of tombs. She will find out on election day whether the cancer is in remission or whether it’s spread to her organs.

“This one’s for me,” she said, pointing to a blank tomb next to her sister’s.

“Mom!” said her daughter with the huffiness of a 9-year-old. “Why would you say that?”

Banda smiled and added, “in a hundred years.”

Bedayn writes for the Associated Press.

WASHINGTON — About half of rural voters identify with Make America Healthy Again, a sprawling political movement championed by the Trump administration, but most said President Trump’s healthcare policies have not benefited their communities, according to a new poll from The Associated Press in partnership with KFF.

About 8 in 10 rural voters — an important voting bloc for Trump and fellow Republicans — said the Trump administration’s policies have had a negative effect or no impact on the health of people where they live. Most MAHA supporters, 68%, also feel this way, according to the national survey of more than 2,000 rural registered voters.

The findings signal an apparent disconnect between the Trump administration’s MAHA-branded policy priorities and rural America’s perception of their reach and effectiveness.

Iowa pastor Mike Jager, 58, is a registered Republican and considers himself part of the MAHA movement. The Trump administration’s health policies have had “minimal” impact on the health of his community, Jager said, but he added that Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.”

“It’s a beginning,” Jager said. “It’s a big ship to try and turn around and course-correct.”

Kennedy has used the MAHA label to support various agendas, including abandoning long-standing vaccine guidance, researching ultraprocessed foods and investing in regenerative agriculture.

Jager lives in Sumner, Iowa, “less than a quarter mile from where the corn ends and the city begins.” He’s seen family members and neighbors develop diseases that he believes resulted in part from exposure to agricultural chemicals and consumption of unhealthy, processed foods.

In the June Republican primary for governor, Jager voted for Zach Lahn, a businessman and farmer who ran on a MAHA platform and beat out Trump-backed U.S. Rep. Randy Feenstra. He plans to vote for him again in November.

Many rural voters are prioritizing health issues

About two-thirds of rural voters who support MAHA said it’s “extremely” or “very” important to them to vote for a candidate who does, too, while only 4 in 10 rural voters overall said the same.

Trump sought to seize on MAHA support during his campaign for another term two years ago. Now, amid tight midterm races, Kennedy has campaigned to galvanize the movement’s support. In May, he attended a MAHA bill signing with Iowa Republican Gov. Kim Reynolds, and in August, he went fishing with Lahn, posting about it on social media.

Yet the survey indicates voters are noticing “this weird split in the Trump administration” between what Kennedy messages and what Trump says and does, said David Peterson, a political science professor at Iowa State University.

In Iowa, concerns about what’s causing rising cancer rates are “a big deal,” he said. For many people who identify with MAHA, being healthy includes taking on corporate agriculture and pharmaceutical companies that they think cause cancer, he added.

In the poll, views on healthcare access and costs largely diverged along party lines. Most Democratic and independent voters said the Trump administration’s healthcare policies have had a negative impact on their healthcare costs and the health and well-being of people in their communities. Republicans were likelier to say there hasn’t been an impact.

Talking on the phone from her 200-acre farm in Carroll County, Iowa, 71-year-old Donna Klocke said that her husband had died from cancer and that she has neighbors who also have cancer.

“It’s just very prevalent,” Klocke said. “We’re in a farming community. We use chemicals and pesticides and all kinds of things that aren’t necessarily good for us.”

Klocke, a Democrat, said the MAHA movement is a good idea because she cares about being healthy, but she does not consider herself part of it and will not be voting for a candidate who represents the movement.

Kennedy, who was an anti-vaccine activist before entering politics and has sent mixed messages to Americans about getting the measles vaccine, scares her.

“Measles are coming back and polio,” Klocke said. “It’s the measles that really gets me. It’s like, do you not understand how dangerous it is?”

Survey reflects angst over healthcare

Nearly half of rural voters said their communities don’t have enough doctors or other healthcare providers, and even more said there aren’t enough mental health workers specifically. The share of rural voters who said their community does not have enough hospitals increased to 35% from 21% in a similar question asked in a KFF-Washington Post survey in 2017.

And as with the general population, healthcare, gas and grocery costs are top pain points. At least 6 in 10 rural voters said they were worried about healthcare costs.

The level of worry varied based on coverage, with rural voters enrolled in employer plans or Medicare less likely to be worried. The survey found that 80% of working-age rural voters on Medicaid were very or somewhat worried about healthcare costs. Last year, Republicans passed a tax and spending bill that cut over $900 billion in projected Medicaid spending over a decade and mandated new eligibility requirements.

In the tiny community of Lipan, Texas, west of Dallas, Kim Solis and her husband have a handyman-and-home-remodel business and get their insurance on the marketplace. Since Trump returned to office, their premium payment jumped from zero to $166 a month. Their copays went up, and their deductibles each increased by $2,000.

Solis, 62, said she worries what will happen if they get a big medical bill.

“Certainly, we’d be in a world of hurt trying to take money out of savings or getting it out of our 401(k) just to be able to do something about it,” she said.

Most MAHA voters are also MAGA — but not all

Like the general population, rural voters said they trust their own doctors and healthcare providers for health information over government agencies or officials, according to the poll.

Trust in Kennedy and Trump fell largely along partisan lines. About 10% of rural Democratic voters reported having a “great deal” or “fair amount” of trust in Kennedy, compared with 74% of rural Republican voters. About 5% of rural Democrats and 69% of rural Republicans said they trust Trump a “great deal” or “fair amount” for reliable health information.

While Make America Great Again and MAHA identities are “linked in a lot of ways,” the rising costs of healthcare and groceries pose a challenge for those committed to the MAHA principles that Kennedy promotes, said Peterson, the Iowa State professor.

Buying healthy food “becomes, ‘I can’t afford to do that because of Trump’s policies,’” he said.

In Stamping Ground, Kentucky, Alma Johnson, 65, works night security at a horse farm.

Johnson voted for Trump in 2016, 2020 and 2024 and said she “pretty much” likes how Trump is running the country. But she said she is not a MAGA devotee, preferring to “think for myself.”

MAHA, however, is an easy sell for Johnson because, she said, she doesn’t think people should be able to buy junk food in the Supplemental Nutrition Assistance Program, or SNAP.

Still, she said she hasn’t seen much impact from the Trump administration’s healthcare policies, including the new food pyramid.

“It takes a long time to change people, their habits, their thoughts or the things they do,” Johnson said.

Swenson, Tribble and Sanders write for the Associated Press.

The poll of 2,241 U.S. adults registered to vote in rural areas of the country was conducted Aug. 12-24, 2026, using a sample drawn from the probability-based SSRS Opinion Panel. The margin of sampling error for the full sample is plus or minus 3 percentage points. In collaboration with AP, KFF researchers worked to design the survey sample and questionnaire, analyze and report findings. This report is a collaboration between the Associated Press and KFF Health News. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.