More than a quarter of adults who bought health insurance on exchanges created under Obamacare skipped important doctor visits and medical tests because they could not afford to pay, a study published Thursday by Families USA found. Among low- and middle-income adults, the proportion of people who avoided care was even higher, at nearly one-third.

More than 14 million people in the United States gained health insurance through Obamacare, landmark legislation officially known as the Affordable Care Act that was passed in 2010. Nearly 12 million people signed up for health coverage plans on exchanges created under Obamacare, according to the website

But more than half of the adults who bought such plans had deductibles of $1,500 or more, Families USA, a Washington nonprofit organization focused on health care, found. A deductible is the cumulative amount a person has to spend on health care before his or her insurance company starts to pay. Despite receiving tax credits to help offset the cost of coverage, these deductibles were prohibitively expensive.

“Simply having health insurance is no guarantee that consumers can afford to pay for health care,” the report noted. When people decided to forgo medical care, fees that would have to be paid out of pocket were a major contributing factor, the report, which surveyed adults with lower- and middle-income levels, found. The report did not include people who had health insurance through Medicaid or those who had health insurance through their employers.

Overall, the Affordable Care Act made health insurance and health care itself more affordable, in part by subsidizing the cost through tax credits to those who qualify. But for some Americans, it was not affordable enough, the report showed. Of adults who were insured for a full year, 25.2 percent did not get necessary medical care, including tests, treatments and medications. Of lower- to middle-income adults, 32.3 percent reported not getting care they needed.

Those with higher deductibles were more likely to skip getting care, and the report recommended that the government redesign one particular level of coverage -- the silver plan -- offered on its exchanges, to lower out-of-pocket costs.

One reason consumers face such high out-of-pocket costs is because being forced to spend more of one’s own money is supposed to stop people from seeking unnecessary care. This policy gained momentum under the Affordable Care Act, the New York Times reported in February. As a result, even though Obamacare vastly expanded the number of people who could access and pay for health insurance plans, it didn’t necessarily ensure that those same people could afford the medical care itself.