As of March 2006, an average of 18 million U.S. families a year face out-of-pocket medical care costs that strain their budgets (and qualified as "high" relative to their income). These families are more likely than others to have trouble getting needed care and paying for it. The share of families struggling under the burden of these costs is up from 1996—and according to this Commonwealth Fund report, more families are likely to spend a larger share of their budgets on health care in the coming years.