More than half of Californians (52%) reported skipping or postponing some form of health care in the last 12 months, with half of those who had done so saying their health worsened as a result.

That’s the finding of a new survey shared by the California Health Care Foundation and NORC at the University of Chicago.

The poll of 1,739 California adults, conducted from Sept. 30 to Nov. 1 last year, found that more than a quarter (27%) said that they or someone they know has struggled to pay a medical bill within the last year. For lower income Californians, that number rises to 44%.

Meanwhile, 65% of Californians say they are worried about unexpected medical bills and out-of-pocket health care costs, with more than a third (36%) saying they have some kind of medical debt. Again, that number rises (to 52%) among people with lower incomes. Of those with medical debt, 19% say that it’s more than $5,000.

Kristof Stremikis, of the California Health Care Foundation, said in a statement that the high cost of health care is taking a toll on millions of Californians.

“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,” Stremikis said.