Housing affordability is a key social determinant of health. Unaffordable housing can lead to housing instability and homelessness, both of which contribute to higher health care costs and poor health outcomes. High housing costs can contribute to a number of other financial challenges as well, impacting essential needs such as food security, employment opportunities in certain areas, and transportation.
Unaffordable housing can also impact more intangible needs, such as access to care, community support, and feelings of stability. Studies have linked housing instability with adverse childhood experiences (ACEs) in children, which have long-term impacts on health.
Unaffordable rent and high housing costs can cause psychological and emotional distress in all ages, perhaps especially for individuals who must seek more affordable alternative housing, whether by choice or eviction, and individuals who face homelessness due in part to lack of housing affordability. In fact, the US is seeing its highest homelessness rate on record, with evictions soaring; the need for rental assistance is greater than ever.
With the many impacts that unaffordable rent has on health, SHADAC researchers sought to explore the burden of unaffordable rent on individuals in the United States. Drawing on SHADAC’s State Health Compare tool, we examined the connection between housing and health by analyzing the latest data from the ‘Percent of cost-burdened rental households’ measure.
This measure comes from the American Community Survey (ACS) and provides information about the percentage of Americans with unaffordable rents. In the ACS and this measure on State Health Compare, the percentage of Americans with unaffordable rent is defined as the percentage who spend more than 30% of their households’ monthly income on rent, which is a common rule-of-thumb to follow when budgeting for monthly rent spending. Breakdowns by disability status, household income, Medicaid enrollment, metropolitan status, and race/ethnicity (White or non-White) are also available for this measure.
To more fully grasp the impacts of unaffordable rent in the U.S., SHADAC researchers analyzed national trends from the last five years, state-level rates of unaffordable rent, and rates for specific subpopulations.
Keep reading below to learn more!
Unaffordable Rent in the U.S. from 2018–2023
To give us a better overall picture of housing affordability in the U.S., we started by looking at the percentage of renters with unaffordable rent at the national level.
In 2018, 46.9% of renters experienced rental burden, while 45.9% did in 2019. The rates were similar in 2021 and 2022, with 47.5% and 47.3% of renters spending more than 30% of their monthly income on rent, respectively.
In 2023, the latest year of data available on State Health Compare, 48.5% of renters were spending more than 30% of their households’ monthly income on rent. This rate is the highest it has been in the last five years that data is available.
Note: Data for 2020 were not officially released by the U.S. Census Bureau due to pandemic-related disruptions to data collection and resulting problems with data quality, therefore data for the last five years goes back to 2018.
Figure 1. Percentage of Renters with Unaffordable Rent in the United States, 2018–2023
As the national rental burden is only increasing, it is important to identify which states and populations are most likely to bear these burdens.
States with Top Five Highest / Top Five Lowest Unaffordable Rent
In 2023, the five states with the highest percentages renters spending more than 30% of their households’ monthly income were Florida (57.8%), Nevada (54.4%), California (53.1%), Hawaii (52.1%), and Oregon (51.4%).
In contrast, the five states with the lowest percentages of rental burden in 2023 were Montana (38.9%), Alaska (38.5%), Wyoming (38.3%), South Dakota (36.0%), and North Dakota (35.8%).
To understand if these state percentages were consistent throughout the years or variable each year, SHADAC researchers also looked at the five states with the highest and lowest percentages of unaffordable rents during the past five years.
Table 1. States with the Highest Percentages of Unaffordable Rents by Year, 2018–2023
2023 Highest | 2022 Highest | 2021 Highest | 2019 Highest | 2018 Highest |
|---|---|---|---|---|
Florida (57.8%) | Florida (55.4%) | Florida (54.9%) | Florida (53.5%) | Florida (53.9%) |
Nevada (54.4%) | Nevada (53.3%) | Nevada (52.8%) | Hawaii (51.9%) | California (52.5%) |
California (53.1%) | Hawaii (52.0%) | California (52.6%) | California (51.1%) | Louisiana (50.7%) |
Hawaii (52.1%) | California (51.6%) | Hawaii (51.1%) | Nevada (50.1%) | Hawaii (50.5%) |
Oregon (51.4%) | Massachusetts (49.1%) | Louisiana (50.4%) | Vermont (48.9%) | Connecticut (49.9%) |
Table 2. States with the Lowest Percentages of Unaffordable Rents by Year, 2018–2023
2023 Lowest | 2022 Lowest | 2021 Lowest | 2019 Lowest | 2018 Lowest |
|---|---|---|---|---|
Montana (38.9%) | Montana (38.6%) | Wisconsin (40.5%) | West Virginia (39.3%) | Vermont (39.7%) |
Alaska (38.5%) | Wyoming (38.5%) | New Hampshire (39.3%) | South Dakota (39.3%) | Nebraska (39.7%) |
Wyoming (38.3%) | Alaska (36.4%) | Montana (37.5%) | Kentucky (39.0%) | Wyoming (38.7%) |
South Dakota (36.0%) | South Dakota (35.3%) | North Dakota (36.6%) | Nebraska (38.2%) | South Dakota (37.9%) |
North Dakota (35.8%) | North Dakota (35.1%) | South Dakota (32.6%) | North Dakota (37.4%) | North Dakota (34.9%) |
Note: Point estimates for small population states such as Vermont often exhibit a large amount of year-to-year variability that is due in great part to the small sample sizes available for these states and the resulting lack of statistical precision (i.e., large margins of error) in any given year. For example, we estimate that, in 2019, 48.9% of Vermont rental households were cost burdened. However, this point estimate had an associated margin of error of 5.8%, meaning that we only have enough statistical precision to say with a 95% level of confidence that the state's true rate of cost burden fell between 43.1% and 54.7% which would put its 2019 state cost burden ranking somewhere between 29th most and 1st most cost burdened. Therefore, Vermont appears in the bottom five states with unaffordable rent in 2018 but then appears in the top five states in 2019 due to its wide margin of error.
Florida consistently ranked as the state with the highest percentage of renters spending more than 30% of their households’ monthly income on rent every year from 2018 to 2023. Demand for housing often exceeds the availability of housing. California, Nevada, and Hawaii also ranked consistently within the top five throughout the past five years. Notably, Florida, California, Nevada, and Hawaii all feel the effects of tourism on rent: many rental properties are experiencing increasing prices due to overall increased demand for short-term vacation rentals.
North and South Dakota consistently remained in the top five states with the lowest percentage of renters experiencing rental burden from 2018 to 2023. Nebraska, Wyoming, and Montana also made repeat appearances in the top five lowest states throughout those five years. The Midwest region remains an area with lower rent prices, with smaller state populations, cheaper cost-of-living, more supply, and less demand, keeping prices lower.
Unaffordable Rent: Breakdowns by Subpopulation
Disaggregated data can reveal disparities in experience and impact of unaffordable housing that may not be clearly visible in the aggregated data. Let’s look at each of the available breakdowns from State Health Compare for this measure to see differences amongst varied communities in 2023.
Disability Status
Households with at least one person with a disability experienced a significantly higher rate of rental burden, with 54.9% spending more than 30% of their monthly income on rent compared to 46.2% of households with no individuals having a disability.
Income Level
Of those with an annual household income of less than $25,000, 83.6% experienced unaffordable rent. This is significantly higher than households with annual incomes of $25,000–$50,000 (67.0%) and $50,000 or more (22.5%).
Figure 2. Unaffordable Rents by Income Level, 2023
Medicaid Enrollment
Households that have at least one person enrolled in Medicaid reported a significantly higher rate of unaffordable rent than households without a Medicaid enrollee. For households with a Medicaid enrollee, 58.9% experienced rental burden; for households without a Medicaid enrollee, the rate was 42.5%.
Figure 3. Unaffordable Rents by Medicaid Enrollment, 2023
Metropolitan Status
The percentage of those spending more than 30% of their households’ monthly income on rent also varied significantly by metropolitan status. Half (50.0%) of individuals that lived in a metropolitan area experienced unaffordable rent, while only 39.4% of individuals living in a non-metropolitan area did.
Race/Ethnicity (White vs Non-White)
Finally, we looked at unaffordable rent by race/ethnicity. Households with only White individuals experienced a significantly lower rate of unaffordable rent compared to households with at least one non-White individual. While 50.1% of households with at least one non-White individual experienced rental burden, only 45.4% of households with only White individuals did.
These breakdowns help identify which populations are the most at risk, which can help direct efforts in maintaining and securing stable housing. This can also help in identifying communities and populations that might be more likely to be experiencing the health impacts of unaffordable housing, and may require tailored programs, services, or resources.
Housing and Health: Rent Affordability Impacts Public Health
Affordable rent is a key driver of health. If an individual spends more than 30% of their monthly household income on rent, they may have difficulty paying for other needs. They may not be able to pay for prescriptions, provider visits, or other essential health care related costs. Thus, high housing costs can lead to numerous other financial and health challenges, such as limited access to care or community, food insecurity, and emotional & mental distress.
Using State Health Compare, we can see that households with an individual (or individuals) with a disability, of lower socioeconomic status (SES), who are enrolled in Medicaid, living in a metropolitan area, or who are non-White experience rental cost burden at higher rates. Thus, it is important for policymakers, community workers, and other stakeholders to create and implement tailored efforts to help impacted individuals secure and maintain affordable housing.
Unaffordable rent also differs by region of the United States, so focusing on creating affordable housing policies in particular states could be worthwhile. As previously discussed, tourism contributes to higher demand for short-term vacation units, which raises the price of rent in these states.
However, some of these states are finding ways to address the high demand for short-term rentals. Recently, Hawaii enacted a law to limit and regulate short-term vacation rentals in hopes to protect the states’ renters and homeowners. California has also issued regulations and bans on short-term rental units in some cities, which has led to decreased prices in rent. California also has rent control laws in place, which protect renters from high price increases and unlawful evictions. While these policies will not change the landscape of unaffordable rent immediately, they are meaningful and tangible steps toward helping mitigate rental burden.
Due to the multiple ways that unaffordable housing costs can impact health and well-being, it is crucial to implement strategies aimed at increasing the availability of affordable rental housing, especially for regions and individuals that are burdened the most.