Small emergency expenses still challenge many Americans after nearly a decade of economic recovery, a new survey released by the Federal Reserve on Tuesday found.

The Fed’s new survey of household economics and decision-making found 41% could not cover a $400 emergency expense using cash in 2017. That’s actually a slight improvement, since 44% could not in 2016, 46% could not in 2015 and only 50% could in 2013.

Those that couldn’t afford the expense turn to credit cards or borrowing from family or friends, while only 5% would turn to a payday loan or similar product.

The inability to pay a bill also highlights the vulnerability of many Americans — 22% say they expect to forgo payments on some of their bills. Nearly half of those who skip bills let their credit cards go unpaid, racking up huge interest rate charges in the process.

One-third of those who can’t pay all their bills say their rent, mortgage or utility bills will be left unpaid.

Americans also are skipping out on health care. In 2017, 27% reported skipping medical treatment due to cost, up from 25% in 2016 but down from 32% in 2013. Dental care and doctors’ visits are what people opt to skip.

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Unique to this year’s report, the Fed asked about the opioid epidemic, and found that one in five adults personally knows someone who has been addicted to opioids. Not surprisingly, those who do know an opioid addict have a less favorable assessment of the economy, though over half of these people still say their local economy is good or excellent.

This finding in some ways pushes back against the “deaths of despair” hypothesis advanced by Anne Case and Angus Deaton. Local unemployment rates are similar in the neighborhoods where those exposed to opioids live and where those not exposed live, the Fed found.

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Overall, 74% of adults say they were doing OK or living comfortable, which has steadily improved over the years and is up over 10 percentage points from 2013.

The racial gap is still stark — whites with only a high-school diploma are more likely to report doing OK financially than blacks or Hispanics with some college education or an associate degree.