One consequence of widening income inequality is in access to healthcare. Prior to the Affordable Care Act, 39% of below-average income Americans reported not seeing a doctor because of cost. This is almost 5.5 times more than low-income Canadians (7%), and 39 times higher than those in the UK (1%). Even within the US there are wide disparities, with low-income adults in Southern states being twice as likely to face cost-related barriers compared to those in Maine and Massachusetts. These barriers not only have impact in them seeking care to begin with, it can also impact their ability to continue and sustain treatment. For example, eliminating medication co-payments among patients who had a myocardial infarction resulted in a 35% decrease in future events, as well as a 70% reduction in total cost.