One in three working-age adults with private health insurance, or 32%, said they were paying medical bills or debt over time, according to Commonwealth Fund research published Thursday. Hospital services were the most common source, cited by 64% of people paying bills over time. Among adults with medical debt, 46% owed at least $2,000, while about one in four said their debt had been sent to a collection agency or reported to a credit bureau. Medical bills also affected household finances and access to care: 68% reported anxiety or worry about medical debt, 30% delayed or avoided needed care, and 36% said they could not pay an unexpected $1,000 medical expense within 30 days. Earlier survey findings said 37% had used savings and 30% had reduced spending on essentials such as food, heat or rent. The nationally representative telephone and online survey included 6,353 adults. The report recommends downstream relief, upstream prevention and broader reforms to the U.S. healthcare system, including interest-free payment plans, stronger hospital financial assistance, removing medical debt from credit reports, easier enrollment through centralized online portals, eliminating deductibles in commercial plans, capping provider payment rates and expanding coverage. About 15 million people have medical bills on their credit reports, totaling an estimated $49 billion. Only Illinois and Minnesota require hospitals to offer payment plans before sending bills to collections, while most states allow medical debt on credit reports under certain conditions or impose no limits.