The structure of social welfare policy has neglected a growing and increasingly economically marginalized segment of the American population-the lower middle class, a large group who are ineligible for many need-based social services. We examined 20-year time trends in physical well-being, mental well-being, and functional well-being by levels of household income. Our descriptive study used data from the Behavioral Risk Factor Surveillance System and is representative of the population of the United States, ages 40 to 74, from 2003 to 2022 (