Of the areas where consumers said they would cut back in a cash crunch, charitable donations were first, followed by student loans, and skipping medical bill payments came in at 12th.

A new analysis by Aite Group found that significant changes are taking place in the way Americans pay bills. These include more digital payments and an overall increase in credit card and debit card spending.

Related: Expect more medical debt in the wake of COVID-19

The report said that of the 15.5 billion bills that Americans paid last year, 406.4 million were medical bills. This totals $86.4 billion in overall spending—not including copayments. The report also noted that medical bills were taking up more of a consumer’s paycheck. “More households are paying medical bills, the average number of medical bills per household is increasing, and the average aggregate amount of medical payments is increasing,” the research firm said in a statement.

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