Ill Americans are not getting the care they need.

In a country with the most sophisticated health care system many often forgo care in lieu of taking care of other expenses.

“Despite spending far more on health care than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording health care and paying medical bills,” Commonwealth Fund president Karen Davis said in a statement.

“This is a clear indication of the urgent need for Affordable Care Act reforms geared toward improving coverage and controlling health care costs.”