One of the myths about health care in the United States that really bugs us is that everyone gets good care, rich and poor, insured and uninsured. Well, tell that to the one-in-five people—59 million people, some of whom are insured—reported skipping or delaying care in 2007. Cost was the biggest, although not the only, factor.

It’s a big alarming jump from the one in seven who reported access problems in 2003 when the Center for the Study of Health System Change did a similar survey.

In 2007, more than 36 million reported delaying care and 23 million people skipped care. That’s 59 million people reporting access problems, according to findings from the center’s 2007 Health Tracking Household Survey. The group has done the survey five times since 1997, and this is the biggest jump in a decade, particularly among Americans with insurance.

Cost was cited as the main access problem, along with rising rates of health plan and health system barriers, such as a doctor or hospital not accepting their insurance, or a health plan not covering a treatment, the study found.

“This is the most up-to-date snapshot of the access problems Americans are facing when seeking medical care, and it’s not a pretty picture, especially for insured people, who increasingly are finding that the access to care once guaranteed by insurance is declining,” said Peter J. Cunningham, Ph.D. co-author of the study funded in part by the Robert Wood Johnson Foundation.

People in poorer or fair health had more access problems than healthy people, and uninsured had more problems than insured. No surprise there. But what’s alarming is that the rate at which the insured reported problems rose by 62 percent.

And—saving what's arguably the worst news for last—the plight of poor kids. Low-income kids had experienced a lot of gains between 1997 and 2003 but that progress has been wiped out. “Low-income children encountered the greatest increase in unmet needs among all children,“ the center reported, reversing the gains they experienced between 1997 and 2003.

“The deteriorating access to care, particularly for vulnerable groups—the uninsured, people in the worst health, and low-income children—are especially disturbing,” said David C. Colby, Ph.D., vice president for research and evaluation at the Robert Wood Johnson Foundation.

Read more about the survey in this Wall Street Journal story.