According to a recent survey conducted by the Commonwealth Fund, more than half of working-age Americans have struggled to afford medical care this year. The survey also found that even people with insurance are struggling to pay medical bills, forcing them to forgo or delay needed care.

Nearly a third of adults reported having medical or dental debt, and nearly half of them said it’s at least $2,000.

Some 57% said at least one-tenth of their monthly budget goes toward health care. Of those with insurance, people who bought their own coverage — including on the Affordable Care Act marketplaces — had the toughest time affording care (57%).

Uninsured adults still report the highest rates of being unable to afford health care and accruing medical debt.

The financial strain of health care has made Americans sicker and often put them in debt. Almost 40% of adults reported skipping or putting off health care in the past year because they couldn’t afford it. Of this group, 57% said their health worsened as a result.

The survey is the latest evidence of how people with insurance are struggling to pay medical bills, forcing them to forgo or delay needed care. It’s clear that the current health care system is failing many Americans, and more needs to be done to make health care affordable and accessible for all.

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