Approximately half of working-age Americans are struggling to pay for health care expenses, according to a new analysis, which also found around 1 in 3 individuals are grappling with some form of health care debt.

Findings released Thursday from the first-ever Health Care Affordability Survey from the Commonwealth Fund show 51% of adults between 19 and 64 years old said it was either very or somewhat difficult for them and their family to afford their health care costs, including 43% of people who reported having employer-based health insurance and 57% who had health insurance through a marketplace or individual plan.

About half of working-age adults with Medicare coverage and 45% of those insured under Medicaid also reported having difficulty paying health care costs. Notably, 65% of working-age adults also said price inflation for other goods and services in the past year had affected their or their family’s ability to afford health care.