https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation

Accessibility links

  * Skip to main content
  * Keyboard shortcuts for audio player

  * Open Navigation Menu
  * NPR logo
  * 
  * 
  * NPR Shop
  * 

> Close Navigation Menu

  * Home
  * News Expand/collapse submenu for News
      + National
      + World
      + Politics
      + Business
      + Health
      + Science
      + Climate
      + Race
  * Culture Expand/collapse submenu for Culture
      + Books
      + Movies
      + Television
      + Pop Culture
      + Food
      + Art & Design
      + Performing Arts
      + Life Kit
  * Music Expand/collapse submenu for Music
      + Tiny Desk Contest
      + #NowPlaying
      + All Songs Considered
      + Tiny Desk
      + Music Features
      + Live Sessions
  * Podcasts & Shows Expand/collapse submenu for Podcasts & Shows
    Daily
      + [morning-ed] Morning Edition
      + [we_otheren] Weekend Edition Saturday
      + [we_otheren] Weekend Edition Sunday
      + [all-things] All Things Considered
      + [fresh-air] Fresh Air
      + [up-first] Up First
    Featured
      + [pchh_podca] Pop Culture Happy Hour
      + [shortwave-] Short Wave
      + [npr_theind] The Indicator from Planet Money
      + [stateofukr] State of Ukraine
      + More Podcasts & Shows
  * Search
  * 
  * NPR Shop

  * NPR Music NPR Music
  * Tiny Desk Contest
  * #NowPlaying
  * All Songs Considered
  * Tiny Desk
  * Music Features
  * Live Sessions

  * About NPR
  * Diversity
  * Organization
  * Support
  * Careers
  * Connect
  * Press
  * Ethics

When medical bills lead to debt, financial hardship piles on top of
sickness : Shots - Health News The U.S. health system now produces
debt on a mass scale, a new investigation shows. Patients face
gut-wrenching sacrifices.
Shots - Health News

Shots

Health News From NPR

  * Your Health
  * Treatments & Tests
  * Health Inc.
  * Policy-ish
  * Public Health

  * Twitter

Diagnosis: Debt

Sick and struggling to pay, 100 million people in the U.S. live with
medical debt

June 16, 20225:00 AM ET
Heard on Morning Edition

Noam Levey

From Kaiser Health News

Sick and struggling to pay, 100 million people in the U.S. live with
medical debt

Listen * 6:58 6:58
Toggle more options

  * Download
  * Embed
    Embed [<iframe src="https:/] <iframe src="https://www.npr.org/
    player/embed/1104679219/1105451267" width="100%" height="290"
    frameborder="0" scrolling="no" title="NPR embedded audio player">
  * Transcript

[world-of-d]
Enlarge this image

Elizabeth and Nick Woodruff of Binghamton, New York, were sued for
nearly $10,000 by the hospital where Nick's infected leg was
amputated. Heather Ainsworth for KHN and NPR hide caption

toggle caption
Heather Ainsworth for KHN and NPR

Elizabeth and Nick Woodruff of Binghamton, New York, were sued for
nearly $10,000 by the hospital where Nick's infected leg was
amputated.

Heather Ainsworth for KHN and NPR

Elizabeth Woodruff drained her retirement account and took on three
jobs after she and her husband were sued for nearly $10,000 by the
New York hospital where his infected leg was amputated.

Ariane Buck, a young father in Arizona who sells health insurance,
couldn't make an appointment with his doctor for a dangerous
intestinal infection because the office said he had outstanding
bills.

Allyson Ward and her husband loaded up credit cards, borrowed from
relatives, and delayed repaying student loans after the premature
birth of their twins left them with $80,000 in debt. Ward, a nurse
practitioner, took on extra nursing shifts, working days and nights.

"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 --
including 41% of adults -- beset by a health care system that is
systematically pushing patients into debt on a mass scale, an
investigation by KHN and NPR shows.

The investigation reveals a problem that, despite new attention from
the White House and Congress, is far more pervasive than previously
reported. That is because much of the debt that patients accrue is
hidden as credit card balances, loans from family, or payment plans
to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR
investigation draws on a nationwide poll conducted by KFF (Kaiser
Family Foundation) for this project. The poll was designed to capture
not just bills patients couldn't afford, but other borrowing used to
pay for health care as well. New analyses of credit bureau, hospital
billing, and credit card data by the Urban Institute and other
research partners also inform the project. And KHN and NPR reporters
conducted hundreds of interviews with patients, physicians, health
industry leaders, consumer advocates, and researchers.

The picture is bleak.

Loading...

In the past five years, more than half of U.S. adults report they've
gone into debt because of medical or dental bills, the KFF poll
found.

A quarter of adults with health care debt owe more than $5,000. And
about 1 in 5 with any amount of debt said they don't expect to ever
pay it off.

"Debt is no longer just a bug in our system. It is one of the main
products," said Dr. Rishi Manchanda, who has worked with low-income
patients in California for more than a decade and served on the board
of the nonprofit RIP Medical Debt. "We have a health care system
almost perfectly designed to create debt."

The burden is forcing families to cut spending on food and other
essentials. Millions are being driven from their homes or into
bankruptcy, the poll found.

Share your story

Are you dealing with medical debt of your own? NPR and KHN would like
to hear from you as we report this special series on medical debt.
Share your story here.

Are you in debt for medical bills you can't pay?

Shots - Health News

Are you in debt for medical bills you can't pay?

Medical debt is piling additional hardships on people with cancer and
other chronic illnesses. Debt levels in U.S. counties with the
highest rates of disease can be three or four times what they are in
the healthiest counties, according to an Urban Institute analysis.

The debt is also deepening racial disparities.

And it is preventing Americans from saving for retirement, investing
in their children's educations, or laying the traditional building
blocks for a secure future, such as borrowing for college or buying a
home. Debt from health care is nearly twice as common for adults
under 30 as for those 65 and older, the KFF poll found.

[allyson-wa]
Enlarge this image

Allyson and Marcus Ward of Chicago moved across the country to be
closer to family after the premature birth of their twins, Milo and
Theo, left them with about $80,000 in medical debt. Taylor Glascock
for KHN and NPR hide caption

toggle caption
Taylor Glascock for KHN and NPR

Allyson and Marcus Ward of Chicago moved across the country to be
closer to family after the premature birth of their twins, Milo and
Theo, left them with about $80,000 in medical debt.

Taylor Glascock for KHN and NPR

Perhaps most perversely, medical debt is blocking patients from care.

About 1 in 7 people with debt said they've been denied access to a
hospital, doctor, or other provider because of unpaid bills,
according to the poll. An even greater share -- about two-thirds --
have put off care they or a family member need because of cost.

"It's barbaric," said Dr. Miriam Atkins, a Georgia oncologist who,
like many physicians, said she's had patients give up treatment for
fear of debt.

Loading...

Patient debt is piling up despite the landmark 2010 Affordable Care
Act.

The law expanded insurance coverage to tens of millions of Americans.
Yet it also ushered in years of robust profits for the medical
industry, which has steadily raised prices over the past decade.

Hospitals recorded their most profitable year on record in 2019,
notching an aggregate profit margin of 7.6%, according to the federal
Medicare Payment Advisory Committee. Many hospitals thrived even
through the pandemic.

But for many Americans, the law failed to live up to its promise of
more affordable care. Instead, they've faced thousands of dollars in
bills as health insurers shifted costs onto patients through higher
deductibles.

Now, a highly lucrative industry is capitalizing on patients'
inability to pay. Hospitals and other medical providers are pushing
millions into credit cards and other loans. These stick patients with
high interest rates while generating profits for the lenders that top
29%, according to research firm IBISWorld.

Patient debt is also sustaining a shadowy collections business fed by
hospitals -- including public university systems and nonprofits
granted tax breaks to serve their communities -- that sell debt in
private deals to collections companies that, in turn, pursue
patients.

"People are getting harassed at all hours of the day. Many come to us
with no idea where the debt came from," said Eric Zell, a supervising
attorney at the Legal Aid Society of Cleveland. "It seems to be an
epidemic."

In debt to hospitals, credit cards, and relatives

America's debt crisis is driven by a simple reality: Half of U.S.
adults don't have the cash to cover an unexpected $500 health care
bill, according to the KFF poll.

As a result, many simply don't pay. The flood of unpaid bills has
made medical debt the most common form of debt on consumer credit
records.

Loading...

As of last year, 58% of debts recorded in collections were for a
medical bill, according to the Consumer Financial Protection Bureau.
That's nearly four times as many debts attributable to telecom bills,
the next most common form of debt on credit records.

But the medical debt on credit reports represents only a fraction of
the money that Americans owe for health care, the KHN-NPR
investigation shows.

  * About 50 million adults -- roughly 1 in 5 -- are paying off bills
    for their own care or a family member's through an installment
    plan with a hospital or other provider, the KFF poll found. Such
    debt arrangements don't appear on credit reports unless a patient
    stops paying.
  * One in 10 owe money to a friend or family member who covered
    their medical or dental bills, another form of borrowing not
    customarily measured.
  * Still more debt ends up on credit cards, as patients charge their
    bills and run up balances, piling high interest rates on top of
    what they owe for care. About 1 in 6 adults are paying off a
    medical or dental bill they put on a card.

Never-ending costs: When resolved medical bills keep popping up

Shots - Health News

Never-ending costs: When resolved medical bills keep popping up

How much medical debt Americans have in total is hard to know because
so much isn't recorded. But an earlier KFF analysis of federal data
estimated that collective medical debt totaled at least $195 billion
in 2019, larger than the economy of Greece.

The credit card balances, which also aren't recorded as medical debt,
can be substantial, according to an analysis of credit card records
by the JPMorgan Chase Institute. The financial research group found
that the typical cardholder's monthly balance jumped 34% after a
major medical expense.

Monthly balances then declined as people paid down their bills. But
for a year, they remained about 10% above where they had been before
the medical expense. Balances for a comparable group of cardholders
without a major medical expense stayed relatively flat.

It's unclear how much of the higher balances ended up as debt, as the
institute's data doesn't distinguish between cardholders who pay off
their balance every month from those who don't. But about half of
cardholders nationwide carry a balance on their cards, which usually
adds interest and fees.

Loading...

Bearing the burden of debts large and small

For many Americans, debt from medical or dental care may be
relatively low. About a third owe less than $1,000, the KFF poll
found.

Even small debts can take a toll.

Edy Adams, a 31-year-old medical student in Texas, was pursued by
debt collectors for years for a medical exam she received after she
was sexually assaulted.

Adams had recently graduated from college and was living in Chicago.

Police never found the perpetrator. But two years after the attack,
Adams started getting calls from collectors saying she owed $130.58.

[20220521-2]
Enlarge this image

Edy Adams of Austin, Texas, was pursued for years by debt collectors
over a $130.68 bill for a medical exam she received after being
sexually assaulted in Chicago. Julia Robinson for KHN and NPR hide
caption

toggle caption
Julia Robinson for KHN and NPR

Edy Adams of Austin, Texas, was pursued for years by debt collectors
over a $130.68 bill for a medical exam she received after being
sexually assaulted in Chicago.

Julia Robinson for KHN and NPR

Illinois law prohibits billing victims for such tests. But no matter
how many times Adams explained the error, the calls kept coming, each
forcing her, she said, to relive the worst day of her life.

Sometimes when the collectors called, Adams would break down in tears
on the phone. "I was frantic," she recalled. "I was being haunted by
this zombie bill. I couldn't make it stop."

Health care debt can also be catastrophic.

Sherrie Foy, 63, and her husband, Michael, saw their carefully
planned retirement upended when Foy's colon had to be removed.

After Michael retired from Consolidated Edison in New York, the
couple moved to rural southwestern Virginia. Sherrie had the space to
care for rescued horses.

The couple had diligently saved. And they had retiree health
insurance through Con Edison. But Sherrie's surgery led to numerous
complications, months in the hospital, and medical bills that passed
the $1 million cap on the couple's health plan.

When Foy couldn't pay more than $775,000 she owed the University of
Virginia Health System, the medical center sued, a once common
practice that the university said it has reined in. The couple
declared bankruptcy.

[world-of-d]
Enlarge this image

Sherrie Foy of Moneta, Virginia, had her retirement plans upended
when surgery to remove her colon left her with nearly $800,000 in
bills and forced her and her husband, Michael, into bankruptcy.
Carlos Bernate For KHN and NPR hide caption

toggle caption
Carlos Bernate For KHN and NPR

Sherrie Foy of Moneta, Virginia, had her retirement plans upended
when surgery to remove her colon left her with nearly $800,000 in
bills and forced her and her husband, Michael, into bankruptcy.

Carlos Bernate For KHN and NPR

The Foys cashed in a life insurance policy to pay a bankruptcy lawyer
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.

Although most expect to repay their debt, 23% said it will take at
least three years; 18% said they don't expect to ever pay it off.

Medical debt's wide reach

Debt has long lurked in the shadows of American health care.

In the 19th century, male patients at New York's Bellevue Hospital
had to ferry passengers on the East River and new mothers had to
scrub floors to pay their debts, according to a history of American
hospitals by Charles Rosenberg.

The arrangements were mostly informal, however. More often,
physicians simply wrote off bills patients couldn't afford, historian
Jonathan Engel said. "There was no notion of being in medical
arrears."

Today debt from medical and dental bills touches nearly every corner
of American society, burdening even those with insurance coverage
through work or government programs such as Medicare.

Loading...

Nearly half of Americans in households making more than $90,000 a
year have incurred health care debt in the past five years, the KFF
poll found.

Women are more likely than men to be in debt. And parents more
commonly have health care debt than people without children.

But the crisis has landed hardest on the poorest and uninsured.

Debt is most widespread in the South, an analysis of credit records
by the Urban Institute shows. Insurance protections there are weaker,
many of the states haven't expanded Medicaid, and chronic illness is
more widespread.

Nationwide, according to the poll, Black adults are 50% more likely
and Hispanic adults 35% more likely than whites to owe money for
care. (Hispanics can be of any race or combination of races.)

In some places, such as the nation's capital, disparities are even
larger, Urban Institute data shows: Medical debt in Washington,
D.C.'s predominantly minority neighborhoods is nearly four times as
common as in white neighborhoods.

In minority communities already struggling with fewer educational and
economic opportunities, the debt can be crippling, said Joseph
Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders,
a nonprofit that provides financial counseling to low-income
Washington residents. "It's like having another arm tied behind their
backs," he said.

Loading...

Medical debt can also keep young people from building savings,
finishing their education, or getting a job. One analysis of credit
data found that debt from health care peaks for typical Americans in
their late 20s and early 30s, then declines as they get older.

Cheyenne Dantona's medical debt derailed her career before it began.

Dantona, 31, was diagnosed with blood cancer while in college. The
cancer went into remission, but when Dantona changed health plans,
she was hit with thousands of dollars of medical bills because one of
her primary providers was out of network.

She enrolled in a medical credit card, only to get stuck paying even
more in interest. Other bills went to collections, dragging down her
credit score. Dantona still dreams of working with injured and
orphaned wild animals, but she's been forced to move back in with her
mother outside Minneapolis.

"She's been trapped," said Dantona's sister, Desiree. "Her life is on
pause."

The strongest predictor of medical debt

Desiree Dantona said the debt has also made her sister hesitant to
seek care to ensure her cancer remains in remission.

Medical providers say this is one of the most pernicious effects of
America's debt crisis, keeping the sick away from care and piling
toxic stress on patients when they are most vulnerable.

The financial strain can slow patients' recovery and even increase
their chances of death, cancer researchers have found.

Loading...

Yet the link between sickness and debt is a defining feature of
American health care, according to the Urban Institute, which
analyzed credit records and other demographic data on poverty, race,
and health status.

U.S. counties with the highest share of residents with multiple
chronic conditions, such as diabetes and heart disease, also tend to
have the most medical debt. That makes illness a stronger predictor
of medical debt than either poverty or insurance.

In the 100 U.S. counties with the highest levels of chronic disease,
nearly a quarter of adults have medical debt on their credit records,
compared with fewer than 1 in 10 in the healthiest counties.

The problem is so pervasive that even many physicians and business
leaders concede debt has become a black mark on American health care.

"There is no reason in this country that people should have medical
debt that destroys them," said George Halvorson, former chief
executive of Kaiser Permanente, the nation's largest integrated
medical system and health plan. KP has a relatively generous
financial assistance policy but does sometimes sue patients. (The
health system is not affiliated with KHN.)

Halvorson cited the growth of high-deductible health insurance as a
key driver of the debt crisis. "People are getting bankrupted when
they get care," he said, "even if they have insurance."

What the federal government can do

The Affordable Care Act bolstered financial protections for millions
of Americans, not only increasing health coverage but also setting
insurance standards that were supposed to limit how much patients
must pay out of their own pockets.

What the White House's actions on medical debt could mean for
consumers

Shots - Health News

What the White House's actions on medical debt could mean for
consumers

By some measures, the law worked, research shows. In California,
there was an 11% decline in the monthly use of payday loans after the
state expanded coverage through the law.

But the law's caps on out-of-pocket costs have proven too high for
most Americans. Federal regulations allow out-of-pocket maximums on
individual plans up to $8,700.

Loading...

Additionally, the law did not stop the growth of high-deductible
plans, which have become standard over the past decade. That has
forced growing numbers of Americans to pay thousands of dollars out
of their own pockets before their coverage kicks in.

Last year the average annual deductible for a single worker with
job-based coverage topped $1,400, almost four times what it was in
2006, according to an annual employer survey by KFF. Family
deductibles can top $10,000.

While health plans are requiring patients to pay more, hospitals,
drugmakers, and other medical providers are raising prices.

From 2012 to 2016, prices for medical care surged 16%, almost four
times the rate of overall inflation, a report by the nonprofit Health
Care Cost Institute found.

For many Americans, the combination of high prices and high
out-of-pocket costs almost inevitably means debt. The KFF poll found
that 6 in 10 working-age adults with coverage have gone into debt
getting care in the past five years, a rate only slightly lower than
the uninsured.

Even Medicare coverage can leave patients on the hook for thousands
of dollars in charges for drugs and treatment, studies show.

[world-of-d]
Enlarge this image

Samantha and Ariane Buck of Peoria, Arizona, say they were turned
away from a physician's office because of money they owed, forcing
them to seek emergency care. They estimate they now have about
$50,000 in medical debt. Ash Ponders for KHN and NPR hide caption

toggle caption
Ash Ponders for KHN and NPR

Samantha and Ariane Buck of Peoria, Arizona, say they were turned
away from a physician's office because of money they owed, forcing
them to seek emergency care. They estimate they now have about
$50,000 in medical debt.

Ash Ponders for KHN and NPR

About a third of seniors have owed money for care, the poll found.
And 37% of these said they or someone in their household have been
forced to cut spending on food, clothing, or other essentials because
of what they owe; 12% said they've taken on extra work.

The growing toll of the debt has sparked new interest from elected
officials, regulators, and industry leaders.

In March, following warnings from the Consumer Financial Protection
Bureau, the major credit reporting companies said they would remove
medical debts under $500 and those that had been repaid from consumer
credit reports.

In April, the Biden administration announced a new CFPB crackdown on
debt collectors and an initiative by the Department of Health and
Human Services to gather more information on how hospitals provide
financial aid.

The actions were applauded by patient advocates. However, the changes
likely won't address the root causes of this national crisis.

"The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go
into medical debt is they don't have the money," said Alan Cohen, a
co-founder of insurer Centivo who has worked in health benefits for
more than 30 years. "It's not complicated."

Buck, the father in Arizona who was denied care, has seen this
firsthand while selling Medicare plans to seniors. "I've had old
people crying on the phone with me," he said. "It's horrifying."

Now 30, Buck faces his own struggles. He recovered from the
intestinal infection, but after being forced to go to a hospital
emergency room, he was hit with thousands of dollars in medical
bills.

More piled on when Buck's wife landed in an emergency room for
ovarian cysts.

Today the Bucks, who have three children, estimate they owe more than
$50,000, including medical bills they put on credit cards that they
can't pay off.

"We've all had to cut back on everything," Buck said. The kids wear
hand-me-downs. They scrimp on school supplies and rely on family for
Christmas gifts. A dinner out for chili is an extravagance.

"It pains me when my kids ask to go somewhere, and I can't," Buck
said. "I feel as if I've failed as a parent."

The couple is preparing to file for bankruptcy.

About This Project

Diagnosis: Debt is a reporting partnership between KHN and NPR
exploring the scale, impact, and causes of medical debt in America.

The series draws on the "KFF Health Care Debt Survey," a poll
designed and analyzed by public opinion researchers at KFF in
collaboration with KHN journalists and editors. The survey was
conducted Feb. 25 through March 20, 2022, online and via telephone,
in English and Spanish, among a nationally representative sample of
2,375 U.S. adults, including 1,292 adults with current health care
debt and 382 adults who had health care debt in the past five years.
The margin of sampling error is plus or minus 3 percentage points for
the full sample and 3 percentage points for those with current debt.
For results based on subgroups, the margin of sampling error may be
higher.

Additional research was conducted by the Urban Institute, which
analyzed credit bureau and other demographic data on poverty, race,
and health status to explore where medical debt is concentrated in
the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of
Chase credit card holders to look at how customers' balances may be
affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with
patients across the country; spoke with physicians, health industry
leaders, consumer advocates, debt lawyers, and researchers; and
reviewed scores of studies and surveys about medical debt.

KHN (Kaiser Health News) is a national newsroom that produces
in-depth journalism about health issues. Together with Policy
Analysis and Polling, KHN is one of the three major operating
programs at KFF (Kaiser Family Foundation). KFF is an endowed
nonprofit organization providing information on health issues to the
nation.

  * medical bills
  * medical debt
  * health care costs

  * Facebook
  * Twitter
  * Flipboard
  * Email

Shots - Health News

Shots

Health News From NPR

Read & Listen

  * Home
  * News
  * Culture
  * Music
  * Podcasts & Shows

Connect

  * Newsletters
  * Facebook
  * Twitter
  * Instagram
  * Press
  * Contact & Help

About NPR

  * Overview
  * Diversity
  * Ethics
  * Finances
  * Public Editor
  * Corrections

Get Involved

  * Support Public Radio
  * Sponsor NPR
  * NPR Careers
  * NPR Shop
  * NPR Events
  * NPR Extra

  * Terms of Use
  * Privacy
  * Your Privacy Choices
  * Text Only
  *