The rising cost of health care continues to be one of California’s most urgent issues, according to a newly released statewide survey conducted by the California Health Care Foundation and NORC at the University of Chicago — with more than one in four Californians (27%) saying they or someone in their family struggled to pay at least one medical bill in the last 12 months, up from 20% two years ago. For Californians with lower incomes, the percentage increases to 44% reporting difficulty paying bills.

Nearly two-thirds (65%) of Californians report they are “very” or “somewhat worried” about unexpected medical bills and out-of-pocket health care costs. More than one in three Californians (36%) reports having some kind of medical debt — a figure that climbs to 52% for those with lower incomes. Of those with medical debt, one in five (19%) reports owing $5,000 or more.

Just over half of Californians (52%) report skipping or delaying at least one kind of health care due to cost in the past 12 months — and of those who delayed care, half (50%) say their condition got worse as a result.

“The high cost of care is now directly impacting the health and financial security of millions of California families,” says Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation. “Californians are also very concerned about a variety of other health issues — including homelessness and mental health, preparing public health departments for the next emergency, and ensuring every community has enough health care workers. But in poll after poll, what we see most consistently is that Californians want and need the rising cost of care to be contained.”