Although households earning less than $48,000 annually have always reported more difficulty accessing affordable health care, the difficulty has worsened considerably in the past year. The number climbed by 11 points (to 64%) among households earning less than $24,000 and 12 points (to 57%) among households earning from $24,000 to less than $48,000.

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Meanwhile, the percentage of adults classified as cost secure (able to access and afford quality health care) has reached its lowest level, with only about half of Americans falling into this category. Although there has been greater change in the proportion of Americans classified as cost desperate and cost secure in recent years, nearly 4 in 10 are cost insecure, showing intermittent or inconsistent difficulty in accessing and affording health care.

The decline in cost security in health care carries serious practical implications for the American public, the study said. Twelve percent of U.S. adults report borrowing an estimated $74 billion to pay for health care last year, and nearly 60% are at least somewhat concerned about going into debt to pay for a major medical event.

“The increase in the percentage of Americans unable to afford health care and medicine has impacted Black, Hispanic and lower-income households disproportionately in the past year, revealing that the already-existing gap between haves and have-nots in affording care is now bigger than ever,” the study said. “These changes may reflect a confluence of factors, including elevated levels of consumer and medical inflation, persistent drug shortages and climbing rates of Medicaid disenrollment due to the expiration of the continuous enrollment provision and major cuts in Children’s Health Insurance Program enrollment.”