Elizabeth Woodruff emptied her retirement account and took three jobs after she and her husband were sued for nearly $10,000 by New York Hospital where her infected leg was amputated.
Ariane Buck, a young father in Arizona who sells health insurance, was unable to make an appointment with his doctor for a dangerous intestinal infection because the office said he had unpaid bills.
Allyson Ward and her husband charged credit cards, borrowed from relatives and delayed student loan repayments after the premature birth of their twins left them with $80,000 in debt.
Ward, a nurse practitioner, took extra day and night shifts.
“I wanted to be a mom,” she said. “But we had to have the money.”
The three are among more than 100 million people in America — 41% of them adults — plagued by a healthcare system that systematically pushes patients into large-scale debt, according to a survey by Kaiser Health News and national public radio broadcasts.
The investigation reveals a problem that, despite renewed attention from the White House and Congress, is far more widespread than previously reported. Indeed, much of the debt incurred by patients is hidden in the form of credit card balances, family loans, or payment plans to hospitals and other medical providers.
To calculate the true extent of this debt, the KHN-NPR survey relies on a national survey conducted by the Kaiser Family Foundation for this project. The survey was designed to capture bills that patients could not pay, as well as other loans used to pay for health care. New analyzes from the Urban Institute and other research partners also shed light on the project.
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More than half of American adults say that in the past five years they have gone into debt because of medical or dental bills, according to the KFF poll.
A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 people, regardless of the amount of their debt, said they never expected to pay it back.
“Debt is no longer just a bug in our system. It’s one of the main products,” said Rishi Manchanda, a physician who has worked with low-income patients in California for more than a decade and served on the board of directors of the nonprofit RIP Medical Debt “We have a healthcare system that is almost perfectly designed to create debt.”
The burden forces families to reduce their spending on food and other essentials. Millions of people are being driven from their homes or going bankrupt, according to the poll.
Medical debt piles up on people with cancer and other chronic illnesses. According to an analysis by the Urban Institute, debt levels in US counties with the highest disease rates may be three or four times higher than in the healthiest counties.
Debt widens racial disparities.
And it prevents Americans from saving for retirement, investing in their children’s education or buying a home.
Perhaps most perversely, medical debt prevents patients from receiving care.
According to the survey, around 1 in 7 people with debt said they had been denied access to a hospital, doctor or other provider because of unpaid bills. An even larger share—about two-thirds—delayed care because of cost.
“It’s barbaric,” said Miriam Atkins, a Georgia oncologist who, like many doctors, said patients had dropped out of treatment for fear of going into debt.
Patient debt is piling up despite the landmark 2010 Affordable Care Act, which extended coverage to tens of millions of Americans but hasn’t slowed the rise of high-deductible health plans that leave patients with thousands of dollars in bills.
Today, the debt of hospitals and other healthcare providers is pushing millions toward credit cards and other loans.
Patient debt also supports shadowy collection activity fueled by hospitals selling debt to collection companies.
America’s debt crisis is driven by a simple reality: Half of American adults don’t have the money to cover an unexpected $500 health care bill, according to the KFF poll.
Many simply do not pay. Medical debt is the most common form of debt on consumer credit reports. But medical debt on credit reports is only a fraction of the money Americans owe for health care, the KHN-NPR survey shows.
According to the KFF poll, around 50 million adults – about 1 in 5 – pay their bills for their own care or that of a family member through an installment plan with a hospital or other provider.
One in 10 people owe money to a friend or family member who has covered their medical or dental bills, another form of borrowing that is not usually measured.
Even more debt ends up on credit cards as patients charge their bills and accumulate balances. About 1 in 6 adults pay for a medical or dental bill that they put on a card.
For many Americans, medical or dental debt can be relatively small. About a third owe less than $1,000, according to the KFF poll.
But health care debt can be catastrophic.
Sherrie Foy, 63, and her husband, Michael, had their retirement turned upside down when Foy’s colon had to be removed.
After Michael retired from Consolidated Edison in New York, the couple moved to rural Virginia.
Sherrie had the space to look after the rescued horses.
The couple had saved diligently and had health insurance for retirees. But Sherrie’s surgery resulted in medical bills that exceeded the $1 million cap on their health plan.
When Foy was unable to pay more than $775,000 she owed to the University of Virginia Health System, the couple filed for bankruptcy.
The Foys cashed in on a life insurance policy and liquidated savings accounts the couple had set up for their grandchildren.
“They took everything we had,” Foy said. “Now we have nothing.”
About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.
Americans have been particularly hard hit by the rise of high-deductible health plans, which require people to pay thousands of dollars out of their own pockets before coverage kicks in.
Even Medicare coverage can leave patients on the hook for thousands of dollars, studies show.
About a third of older people owe money for care, according to the survey. And 37% said they or someone in their household had been forced to cut back on food, clothing or other essentials.
The widespread burden of medical debt has sparked new interest from elected officials, including the White House, which in April announced new initiatives to crack down on debt collectors and track hospital financial aid.
The changes are unlikely to address the root causes of this national crisis. “The #1 reason, and #2, 3, and 4 reasons, why people take on medical debt is that they don’t have the money,” said Alan Cohen, co-founder from the Centivo insurer who has worked in health benefits for decades.
Buck, the father from Arizona who was denied care, saw this firsthand while selling health insurance plans to the elderly. “I’ve had elderly people cry on the phone with me,” he said. “It’s horrible.”
Buck, now 30, recovered from the gut infection, but after being forced into a hospital emergency room he was hit with thousands of dollars in medical bills.
Today, the Bucks, who have three children, estimate they owe more than $50,000.
“We all had to scale everything down,” Buck said. Children wear second-hand clothes. They skimp on school supplies and rely on family for Christmas presents. “I feel like I failed as a parent.”
The couple are about to file for bankruptcy.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization.