U.S. adults identify the requirement for insurance approval before receiving medical care as the most significant hurdle to navigating the healthcare system, according to a KFF poll released Monday.
While affordability remains the public’s primary economic concern, the poll found that seven in ten insured adults (69%) view prior authorizations—the process of obtaining insurance approval before accessing certain tests, treatments, or medications—as a burden.
Of those, 32% described it as a “major burden,” a figure that exceeds the share of people struggling with understanding medical bills (23%) or finding providers who accept their insurance (17%).
“Prior authorizations… are having an outsized impact on insured adults, the report stated, noting that one in three adults (34%) chose the process as their single biggest healthcare burden beyond cost.
Chronic Conditions and Delays
The burden is even more pronounced for individuals with chronic conditions requiring ongoing treatment, who represent about half of all adults. Nearly four in ten (39%) of these patients identified prior authorizations as their primary obstacle, at least double the share who cited any other navigational issue.
The KFF findings highlight significant friction between patients and insurers.
Two-thirds of all adults (66%) characterized delays and denials of care by insurance companies as a “major problem. In the past two years, 33% of insured adults reported being denied coverage for a doctor-prescribed service, while 29% were forced to try lower-cost alternatives before their insurer would cover the recommended treatment.
These administrative hurdles carry tangible consequences for patients. Among those who experienced insurance-related delays or denials:
34% reported a “major negative impact” on their mental health and emotional wellbeing, while 33% cited a major negative impact on their finances and 26% said it severely affected their physical health.
Bipartisan Consensus
The frustration with the insurance approval process appears to transcend political and insurance boundaries. Approximately one-third of Democrats (35%), Independents (36%), and Republicans (32%) all identified prior authorization as their single biggest healthcare burden.
Similarly, the issue was cited as the top concern by individuals across various insurance types, including those with employer-sponsored plans, Medicaid, and those who purchase their own insurance. The researchers noted that while prior authorization is common in Medicare Advantage, the analysis did not separate traditional Medicare from Medicare Advantage participants.
The KFF Health Tracking Poll was conducted January 13-20, 2026, among a nationally representative sample of 1,426 U.S. adults. The survey was administered online and by telephone in both English and Spanish. The margin of sampling error for the full sample is plus or minus 3 percentage points.