A new report shed light on the growing share of costs shouldered by families who get health insurance through their employers. The report from The Commonwealth Fund, a private, independent foundation, finds that premiums and deductibles for these Americans now take up 10% or more of median income in 37 states.

That’s compared with just 10 states a decade ago.

The report finds that 11.6% of median income now goes towards paying for premiums and deductibles. That’s because costs for both are rising, while incomes haven’t kept up, said Sara Collins of the Commonwealth Fund.

“We’re going to continue to see growth in prices over time and we’ll continue to see these trends in affordability in employer plans if these underlying drivers aren’t addressed,” she said.

The analysis looks at price increases over the decade between when the Affordable Care Act became law and 2020, when the pandemic started.

In some states, like Mississippi and New Mexico, the share workers pay is approaching double the national average. Michael Gusmano at Lehigh University, said high costs impact decisions people make.

“So they give up on care they really need and/or they’re just hurt financially because they’re not able or willing to give up on the care. So they have to pay more and more out of pocket,” he said.

That can result in higher medical debt over time.