States underwrite less and less of the costs of colleges, and students pick up the difference.
Some years back when I told my son that when I first went off to college that it was possible that a summer job at minimum wage, provided you lived at home and saved most of your wages, would cover tuition and fees at a public university in my state, he looked at me as if I were speaking Martian. His experience was that the very best a frugal student could do was to cover some small percentage of the costs.
As an aside, among the reasons medical costs are so high is that the cost of medical school is so high. Someone going to medical school should not be incurring a six figure debt. Well, no on going to college should incur a high debt, but medical school can be seen as a special case. When I become dictator of North America I'd summarily wipe out all medical school debt, and try to figure out how to encourage new doctors to go into rural areas to serve underserved populations.