Two out of every five adults nationally, or 41 percent, reported problems paying medical bills or were paying off medical debt over time in 2012, while an estimated 84 million people did not have health insurance for the full year or were underinsured, according to a new report.

The Obama Administration’s Home Affordable Modification Program, or HAMP, marks its fourth year this month, with 856,154 households under “permanent” mortgage-reduction plans to help avoid possible foreclosures. But is has been a tough four years and the program continues to lag behind the initial goal of helping up to 4 million homeowners.