With record high insured rates, many Americans still cannot afford the care they need.

Despite historically high levels of health insurance coverage, 46% of working-age adults skipped or delayed care because of cost in the past year, and 42% struggled to pay medical bills or were paying off medical debt, according to the Commonwealth Fund Biennial Health Insurance Survey.

The survey's results spotlight growing health care costs — particularly for hospital inpatient and outpatient services — that are squeezing Americans whose insurance doesn't provide adequate financial protection, even as overall coverage continued to improve.

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