Half of U.S. employees with employer-sponsored health care said in a recent survey that paying their share of that coverage is causing them pain. Worse, nearly all of them said the stress was contributing to a decline in their health.

Those were among the discouraging findings released by PayMedix, a firm that extends credit to consumers in exchange for paying outstanding medical debt. PayMedix polled more than 1,000 such plan members, as well as 210 HR benefits managers, to gauge the effects employer health plans and skyrocketing medical costs were having on insured consumers.

The survey found that out-of-pocket costs, coupled with high deductibles, were particular sources of concern. Survey highlights include:

• Out-of-pocket costs: 33% said they were unable to afford them.
• Deductibles: 31% said they were unaffordable. Additionally, 44% of those with a credit score of 669 or less found deductibles unaffordable.
• More than half said the situation had been exacerbated in the last six months when paying for medical bills came due.
• Collection notices are mounting: Nearly 1 in 5 Americans have received collection notices from their medical providers, with a third of millennials (34%) and a quarter of Gen Z (27%) getting sent to collections.
• Less than 1 in 5 report that their employers provide a payment solution that offers credit, or a solution that simplifies the billing experience.
• Half of those surveyed, and nearly two-thirds of Gen Z (64%) and Millennials (65%), believe employers should be responsible for a solution to the dilemma.

Among the HR folks surveyed, 72% said they are likely to consider a simplified billing experience that offers financial security for all employees. However, fewer than 4 in 10 claim they currently have solutions in place