Legislators in at least six states this year have approved measures related to patient medical debt, according to a report on legislative policy trends released Wednesday by United States of Care, a nonpartisan think tank.

Many Americans are struggling to afford healthcare. A recent survey found that 46% of adults, regardless of their health care insurance status, reported struggling to pay for medical care last year.

Indiana, Louisiana, Maine, Oregon and Washington enacted laws this year related to medical debt. Hawaii legislators have approved a measure that is awaiting the governor’s signature, and other states have bills in committee.

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In 18 states, legislators introduced or approved measures related to preserving no-cost preventive care, and a dozen states weighed legislation related to hospital facility fees, according to the report.

Louisiana enacted a law that limits the interest that providers and debt collectors can charge on medical debt. The new rule caps the annual interest rate on medical debt for “medically necessary care” at 3%. The law defines such care as services or medications deemed necessary by a licensed health care provider to prevent, diagnose or treat an illness or disease symptoms.

Under Washington’s new law, unpaid medical bills can’t be assigned to a debt collector for at least 120 days after the first billing statement in situations where the patient is a pedestrian or bicyclist who has been struck by a motor vehicle. Maine’s law prohibits debt collectors from salary or wage garnishing for medical debt. And Hawaii’s legislature passed a medical debt forgiveness bill that is awaiting the governor’s signature.

Indiana enacted a bipartisan measure that requires hospitals to inform patients of financial assistance programs for which they might be eligible before debt collection begins. The law also requires such information to be posted inside hospitals. It also prohibits health care providers from using automated tools to submit health benefits claims without a provider first reviewing the claims.

Last year, Alaska Democratic state Representative Genevieve Mina introduced legislation that prevents medical debt from showing up on patients’ credit reports. Michigan lawmakers introduced a similar bill, which has been referred for a second reading. And on Tuesday, Massachusetts Democratic Governor Maura Healey proposed an action that would stop medical debt from being reported to consumer credit agencies.

New Mexico enacted a law prohibiting hospitals from charging patients facility fees for preventive outpatient care, vaccinations and telehealth, but preserves facility fees for inpatient and emergency care.