The Sunday Story: The Unbearable Weight of Medical Debt
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I'm a shark. O and this is a sunday story. Across the country, people lose their homes, empty their retirement accounts, some struggle to feed and clothe their families, all because they face crushing medical bills.

For more than a year in P, R, and our partner K F, F, health news have been investigating medical debt. The project has exposed the enormous scale of this problem. More than one hundred million people in the U.

S. Are settled LED with some kind of health care there, often forcing them to make heart ring sacrifices. People like panel py wing guard from salt north carlino.

And it's like, is europe punished for being sick and is not your fault and no one should feel like they're being punished today.

M P, R health correspondent, you can nagur I and no one levy from K, F, F health news are here to talk about the project, the people they've met during the investigation and the impact their reporting is having. So welcome to you both.

hi. Thank you.

So when we're talking about medical debt, what exactly do we mean? Are we talking about medical bills that people don't pay or can afford to pay, or just any medical bill? What is medical debt history? Ally, I think .

people thought medical, that is a medical bill that someone couldn't pay IT ends up getting reported to a credit po on people's credit scores and and that traditionally is the way that medical that was actually calculated.

But the truth is that vastly under states can how big this problem is because a lot of people, when they get their medical bills or their dental bills, they're putting IT on a credit card and then they don't pay the credit card off. And the credit card debt lingers for maybe years at a time. Well, that's not technically medical debt, it's credit card debt.

But IT IT comes from a medical bill, the same thing with a payment plan. Increasingly, ly, a lot of patients go on payment plans with a hospital or a doctor, and they are paying hundreds of dollars a month for like three or four years or maybe they borrow money from a bank or a paid lender or friends or family, and they are in debt to pay off this medical bill. But IT doesn't actually get recorded as as medical. That and when you put that all together, that's how you get one hundred million people.

okay. So it's not just the the actual bill being paid is if you have to put IT on a credit card or go to your mom or whatever, it's it's all of that. Um U K, I know you were digging into some of the statistics around medical debt. So so what were you saying?

Yeah so to understand just how broad the problem with our partners at K F F did a poll asking people about their experience with health care dead and they pulled more than twelve hundred people across the country. And the survey found forty one percent of U. S.

Adults have healthcare debt. That is huge. But the K F F. Polling also found that there are groups bearing a portion onate share of that burden.

So black americans are fifty percent more likely to have debt. And low income people, you know, they have a lot less margin to play with. And so they are more than twice as likely to Carry debt from medical bills. And Young people below thirty are actually more likely than seniors to Carry this kind of debt. So I think overall, when you look at that number, IT tells the story that it's really the people least likely to afford IT who are Carrying this kind of debt.

And so wouldn't just talking about the uninsured here, right, like people who don't have health insurance or are we just talking about people who are uninsured?

Well, it's true that people who lack health insurance are more likely to Carry debt than than those who have health coverage. This is actually a problem that touches people who have all kinds of health insurance too. And that's increasingly because many of us um have these health plans where we have to pay thousands of dollars out of pocket before our health insurance kicks in. And so you know, if you go to an emergency room with a hangnail, you can get out there for less than twenty five hundred dollars. And you know, if you have a hyder duple health insurance plan and you don't have money in the back.

you're gna end up in debt. I know i've live that. You know, when I have my kids, I was not a host that that, you know, I got those thousand dolbear and I had to call up the hospital and say, look either, I don't know if you can do a return policy, baby, we can do a payment plan.

You know, you should just really quickly. One thing we saw that was really kind of sobering was that the people we heard from most frequently were new parents who didn't expect that even a standard labor and delivery the kid comes home with you doesn't go to the nick you you still have thousands of dollars that was mine.

and they charged for you. And a baby, a baby got bills. I just had a baby. This added no complications. When people think that the whole point of insurance is to pay medical bills I ate.

Isn't that the point? Well, IT is. But as known said, you're seeing higher deductable plans, less coverage for the interest that you do have, and it's harder for patients to navigate that and know what's covered and what isn't.

So if people are burdened by this much dead, how are they coping?

Well, there's the emotional coping which has negative effects on your health, right? So there's A A vicious cycle going on there. But the gut watching part of IT is also the financial sacrifices that these families make.

Sixty three percent of those with medical debt. So they cut back on basics like food and close. Forty percent took on extra work. And a few of people with medical that had to change their living situation as a result of that debt.

No uh you also explored um the particularly troubling impact that medical debt is having on minority communities and how that deep bds racial departed and health talk to me more about that yeah you know this is one of the kind .

of particularly uncomfortable truths I think about medical debt in this country and that is that IT is perpetuating Frankly, ugly legacy of racial discrimination in this country. And so so I mean by that well we looked at one community, in particular, nox feel tennessee, which was historically very segregated. The east part of town was where the black community was centered.

And for many years in the eighteen hundreds, IT was poor. But there were businesses, there were churches, doctors, lawyers, theatres. And then after the second world war, the city basically leveled that whole part of town to put in a freeway, build a bunch of parking lots in a civic center, and IT basically a violate kind of what black wealth there was in that part of town.

Hundreds of homes were torn down, churches, more than one hundred black own businesses, and basically never. And when you look now at where medical dad is concentrated in this community, and this is repeated all over the country, but if you look at oxfam medical, that is three times higher in that part of town, the black part of oxford, then IT is in the western suburbs of the city, which which is predominantly White. And if you think about IT, there's a reason for that. If you if you have lower rates of homeownership, you don't have the wealth. And if you get a big bill, a big medical bill.

you can't pay IT. And so IT becomes this vicious cycle where medical that is essentially another barrier for people who've historically been held back by discriminatory policies and housing and employment.

And so worth you're listening .

to the sunday story will be right back.

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We're back with the sunday story talking with U A, gucci and known, leaving about the impact medical debt is having on families across the country.

So in the .

course of your reporting, both of you talk to a lot of people directly affected by metal dead. What did they tell you?

We talk to hundreds of people across the country. People who lost their homes had to cut back on food, drain their retirement accounts, put off their education. One family that that really stuck with me are the box arian and and cement the box.

They live just outside photo x. They have three kids. They work, but they don't have a lot of money.

And we've had their share of medical chAllenges over the years. Several trips to the E R. SHE had a very insist he had in a testable infection. One of their kids is autistic, and they say IT all added up to about fifty thousand dollars in medical debt, and that LED to a lot of scrimping, arian said. That's been really hard on the kids.

They want to go to the mall, they want to go to just on trips to like the dona or flag staff and day trips, but that even that little bx for money is just too much. And if we just don't have IT and .

said they sometimes go without school supplies, they rely on family for for Christmas gifts .

yeah makes you a fair like i'm not giving my kids the best life, uh, possible. I mean, the best I can do form as just put a roof over their head and that just makes me .

feel terrible and that's that's really hard. I mean, that sounds like they're just trying to just trying to make IT and have a irregular life in and provide for their kids that its its the heart braking IT .

is and and you know another kind of really perverse impact of this medical that problem is that it's actually blocking people from getting the care they need. We found that one in seven people said they'd been turned away from a docker or a hospital or other provider because they owed money. And this happened to area and bug too. He came down with A A really bad stomach bug a few .

years ago and I was wasn't keep on anything down. I wasn't able to use the bathroom properly. The point where I was really concerning um then I try to call my doctor that I had at the time but to go to see him however, when I called to make the appointment, I was denied due to me owing them less than one hundred hundred .

actually he ended up having to go to the emergency actually and and thankful he recovered but the visit meant thousands of dollars in more bills because the care was uncovered. And you know, the whole experience just left the box feeling pretty disillusions.

So the box are talking about debt related to physical health care. But I think most of us know that mental health care can also be very expensive, like there are a lot of people struggling with that as well, right?

Well, that's right issue. I mean, I think that's where you find a lot of hidden debt. You know, for years now, we've had this mental health crisis and not enough care to go around.

And really, what this means is that even if you have insurance, you there might not be a psychologist or social worker in network or close enough to make any sense to go to. And I talked to this one woman, Rachel, a woman from michigan n. We're only using her first name to protect her family's privacy. And when her teenage son desperately needed impatient help, the family was repeatedly denied insurance coverage for her son's care for various reasons. So at the time, he was spending twelve thousand five hundred dolla month for a theraputics, not something we could do for very long, having spent, you know, easily a quarter of a million dollars by that .

point on his care of our savings is gone. how? How are we gonna send kids at the school? How are we going to like? How are we going to recover? I don't know those thoughts in your mind, like there is no space for that when you are just trying to keep your child alive.

And retail says he likes to point out that SHE is a woman of privilege. Anyway, SHE had insurance, SHE had savings, but now SHE settled with this debt. And det, that creditors would even classify as medical dead right because we're talking about credit cards and other consumer loans.

Yeah I mean that is a crushing amount that um but even for people who are not dealing with like huge medical deals, there are all these like smaller debts out there that can be still upsetting. Um I think you guys have a particularly infuriating story about a Young woman who was haunted by the small debt.

Yeah, we met e diatoms during our reporting as well. She's a medical student down in texas. But when he was an undergraduate in chicago, SHE was sexually assaulted and went to the hospital and underwent medical exam, and SHE had to move on with her life. And then couple years later he gets out of the out of the blue a call from uh a collector saying he owes like one hundred and thirty one dollars for this rape kit that he had gotten after the assault and SHE tried to explain that a lot of states have laws that bar medical providers from charging rape victims and the medical collector you know said, okay, we will put this in the file and that was that and then you know six months later you would get another .

call so I just kept getting like passed around and no, whenever actually did the thing where they like made IT go away. They just made IT go away for them not for .

me and so basically um these calls just kept coming and coming for years he would plead with people to to take this deck off of her record but you know SHE SHE said I was basically like being forced to relive the worst day of her life because this one hundred and thirty one dollar dutch .

just wouldn't go away. This happened like when I was in work, when I wasn't class. IT happened while I was driving once I like, literally had to pull lover because I .

would be like shaking yeah, it's just like, I mean, the worst day of your life and then to be chased you know we've heard just a small sample right of millions of stories of family dealing with crushing medical debt um and the thing about medical debt is is not like it's necessarily avoidable. Is not like we just don't get sick no, that can't you know just just don't do IT. But U K, you've looked into a group that has found a way to try to relieve some people of this dead.

Yeah, that's right. I mean, as you mention, like people don't get into this debt by choice and they often don't have any preparation. And yet there are not a lot of places for individuals to get help to navigate this.

There's no government program, for example, that helps people sort of once they are in debt, to navigate that process. But there are some nonprofit groups, like free legal aid groups in states and stuff like that. I also found a couple of others, like one called dollar for that's F O R dollar for, helps people try to qualify for financial assistance at hospitals.

And then I found another group called R I P medical debt, uh, and this group IT sort of was stood up to help people once they're sort of mostly in the collections process, you know, already incurred the debt. Uh, and R I P medical debt has this clever way of getting rid of bad medical debt, often thousands of patients at a time. So it's like the opposite of just helping each individual.

R I P sort of identifies that held by lower income people, and then they buy that up at about one percent of its face value. And then instead of turning around and trying to collect on those deads, they just forgive IT and they simply array IT, often thousands of loans at a time. You know, if you're in dead, you can't apply and you can ask for their help.

They just kind of buy the loans that they're able to buy that meet their requirements and they're funded by donors, a lot of small individual donors, but also billionaire philanthus m. Mackenzies Scott, among others. And at the time that our story aired, they had retired six point seven billion dollars and helped three point six million people. But they since doubled the number of people that theyve helps. And with a digital donations that have never retired.

ten point four billion dollars with the dead. So when you say that they just forgive, the date is anymore, say you need to pay this, get those mean letters in the mail .

got is gone. Yes, I mean, that sounds kind good to be true, which is actually reaction in Carry. Logan, I talked to described, you know, sh'd had a complicated birth about fifteen years ago, and sh'd been a mouth teacher at the time.

SHE incurred debt. SHE couldn't pay and was hounded by creditors until out of the blue in twenty twenty two, when he got some yellow letters from R I, P. Medical debt, saying they've done away with the debt for her way.

Who does IT by that time? You know.

sh'd suffered a lot from all those years about worrying about the debt.

No, IT was tough. Every like every day was tough. Every day. I'm thinking about what I oh, i'm going get out, especially with, you know, the money company and just not been enough.

So relieving that dead didn't just liberate her financial issue described how IT liberated her soul.

But you know, the thing is that these individual acts of charity, inspiring as they are, they're not going to solve this problem in in our current system. Even if you have health insurance, there are limits.

Yeah I mean, IT seems like this is definitely a systemic issue. I just wonder why. Why is IT like this? I mean, I think I think a lot of .

people end up asking exactly that question. I asia and and and the reason is kind of the unique and really messed up way that we organize our health insurance in this country. One thing that happened to health insurance in amErica over last twenty and twenty five years is that it's fairly dramatically change where people who did have health insurance used to have most of their medical bills covered.

If you didn't have health insurance, that was something else and that was a huge problem. But what happened is that more, more people have ended up in high deductable health plans that don't cover h thousands of dollars of the of their bills. And you know, if you have a two thousand or a three thousand dollars bill and you only have five hundred dollars in your savings account, IT doesn't take a nobel prize in economics to realize that you're gonna end up in debt. Even if we buy up all the debt that out there and retire IT tomorrow, the cycles are going to start all over again as long as health insurance doesn't protect people financially when they get sick.

We have started to see the federal government and in some states take some action on medical debt. Like can you tell us about some of those changes?

So yes, that the by administration has um stepped forward and the consumer financial protection bureau, which was this agency created after the two thousand and eight two thousand nine financial crisis, has talked about extending some protections for people from the worst kind of excesses of medical debt collections for example. Um the c fpb is talking about taking medical bills off of people's credit scores, which could be really, really consequential in helping people run apartments, get jobs. That said, we've seen states like colorado and maryland, new york step forward and try to put an end to things like hospitals putting leans on people's homes or garni shing their wages, or trying to make sure that hospitals do a Better job of identifying patients who need help before suing them.

So that being the case, as things slowly change, what can people do to protect themselves? Are there any tips for preventing or paying off medical debt?

Yeah I mean, a couple of top level points that I heard very frequently is, you know, to the extent possible, before you get care, do some research and ask questions so you will know what the care will cost you. You know what does insurance cover? Will IT cover all the services you need to get? You know, does your hospital or health system offer any financial assistance?

The charity care I mentioned earlier, you know you don't have to be living below the poverty level to qualify for any those programs. You can apply for that assistance a regardless of your immigration status. And even if it's after you've had the care, you, their advice, seek financial assistant.

And then the other major point is just to self advocate you every single person who works with consumers told me that they tell patients, just keep arguing your case, you know, don't take no for an answer if you turn down for charity care, try again or ask if you can get a discount on those services anyway or be put on a payment plan. But absolutely self advocate of medical bills are far more negotiable, I think, than most patients realize. You there are billing areas. Maybe you were overcharged or should have been considered for financial .

assistant in the first place? no. Do you have any last thoughts like we should be considering when IT comes to medical debt?

Yeah.

I mean, I just think this problem is so big and it's gonna require some pretty big changes in order to Better protect people, I think. But you know, one of the things that I think is important is for people to speak out.

There's a lot of shame with medical that and people people don't want to talk about IT, but I sort of feel like hospitals and doctors and insurance companies and drug makers and the people who run this system and in many cases are making a lot of money in this system. I feel like they need to be confronted by what this system is actually doing to people on a daily basis. It's eroding their their housing security.

It's making IT difficult for them to get food. And and that's not onna change unless we sort of speak up and patient speak up and talk about what's happening um because you know it's not what a health insurance system should be doing. Frankly.

I want to think both of you for being here today and sharing some of your reporting on this issue that impact so many people.

Thank you. Thank you, asia.

This episode of the sunday's story was produced by Andrew mambo and IT was edited by genie h. Mitt and jane Green hosh. The engineer for this episode was Maggie lothar, our team closely on a simply room just yan and ireen. Gucci is our executive producer we always love hearing from you, so feel free to reach out to us at the sunday story at in pr, that ord, am I shark o of forces back in your feet tomorrow with all the new study to start a week. Until then, enjoy the rest of your week.

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