For many Americans, making their health a priority comes at a terrible cost. According to a new study published in the American Journal of Public Health, medical expenses are the cause of two-thirds of bankruptcy filings. It’s not just those with low incomes; medical expenses can hurt families at all income levels.

The study, led by Dr. David Himmelstein, Distinguished Professor at the City University of New York’s Hunter College and Lecturer at Harvard Medical School, suggests that about 530,000 families each year are financially ruined by medical bills and loss of income resulting from illnesses.