For Americans, paying for health care is often a hardship even for those with health insurance, with many people saying they struggle to afford rising premiums, deductibles, copayments and other medical costs.

Just over half of working-age Americans say they sometimes can't afford health care, according to The Commonwealth Fund. About 4 in 10 workers with employer-sponsored insurance or who are on Medicaid say they have difficulty paying, while that rises to about 6 in 10 for people who buy coverage through the Affordable Care Act's marketplaces, the study found.

By comparison, three-quarters of people without insurance who report problems affording care, according to the advocacy group, which promotes fairness in health care.

Almost two in five, or 38%, of insured Americans reported delaying or skipping necessary treatment or medication because of high out-of-pocket costs for health care. Rising medical costs are also straining household budgets, with roughly 30% of working-age adults with health insurance saying these expenses make it difficult to afford essentials like food, utilities, car payments and loans. 

"It's much better to have insurance. People who are uninsured report higher rates of problems with not getting care because of the cost," health care scholar and lead study author Sara Collins told CBS MoneyWatch. "But they also indicate insurance coverage frequently fails to provide affordable access to care for large segments of the population."

This is unsustainable for our health care system, and our nation — we need major reforms to ensure people can get the care they need, when they need it most," 

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