The percentage of Americans facing high out-of-pocket health care expenses and insurance premiums continues to increase, according to a new Commonwealth Fund–supported study published by Health Affairs. In 2006, nearly one of five Americans—19.1 percent of the nonelderly population—lived in families spending more than 10 percent of before-tax income on health care, up from one of seven Americans (14.4%) in 2001. The study found that even before the onset of the economic recession, the financial burden of health care—the ratio of total out-of-pocket spending for health care services and premiums to total family income—was increasing for many Americans. People with private health insurance, including those with employer-sponsored coverage, were affected the most, as out-of-pocket spending rose faster than family incomes.