Medical Bills Still Take A Big Toll, Even With Insurance

Mar 8, 2016
Originally published on March 11, 2016 2:59 pm

For Barbara Radley, there is "before" and "after." Before was when she could work — moving furniture, and driving a long-haul truck.

"It was nothing for me to throw a couch on my back and carry it up a flight of stairs," says the 58-year-old from Oshkosh, Wis.

Then there's after. After she herniated five disks in her back. And after, she says, her blood pressure medicine destroyed her pancreas.

Now Radley is disabled, suffering from diabetes, liver failure and scleroderma.

And she is bankrupt.

"Well, the medical bills were just piling up," Radley tells Shots. "We couldn't handle it. We just couldn't keep up."

Radley is among the 26 percent of people in a recent poll who say health care expenses have taken a serious toll on family finances. The poll, conducted by NPR, The Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health, shows that even people with medical insurance are still struggling to pay medical bills.

Radley and her husband, also a mover, were getting by on his paycheck and her disability payments, which together brought in about $30,000 a year.

But, two years ago, they were hit with a double whammy. His company changed to a health insurance plan that required the couple to pay higher premiums — about $700 a month — higher copays and a $5,000 deductible.

Then her husband needed emergency surgery and missed a few months of work.

"That just killed us financially," Radley says.

They moved out of their family home and rented a place from her daughter-in-law. They stopped eating out — except once in a while, when they'd get a free meal at their church.

Still they ended up in bankruptcy early last year. They were able to write off their old medical debt, but the health problems didn't go away. Barbara's costs are constant and her husband had another surgery last fall. In the past 12 months they've racked up an additional $10,000 in unpaid medical bills.

"Everybody wants your money and it's like, 'Well, stand in line; you ain't gonna get none,' " Radley says with exasperation.

According to the poll, Radley has plenty of company. Of the people who said health costs have caused them serious problems, 7 percent ended up in bankruptcy.

Radley now makes Faustian bargains on a regular basis.

"There are times I check my blood for my insulin and I know I only have two pens left," she says. "And I really can't afford it for another week and a half. Well, then I take a lower dose of my insulin. Otherwise I'll just skip it."

But skipping insulin also can be dangerous, Radley knows.

"If I would skip it for several days that would put me in the hospital," she says, "and that just gives me more bills."

On Monday she was trying to decide whether to take out a payday loan or sell something on Craigslist to cover her insurance plan's $454 copay for two months of insulin.

A study last year by the Kaiser Family Foundation found that companies are shifting health care costs to their employees. Workers' share of health insurance premiums for their families rose 83 percent from 2005 to 2015, the survey shows. The amount employees had to pay for deductibles for individual insurance increased 255 percent from 2006 to 2015. The increases are far higher than growth in workers' wages.

That hurts the sickest people the most, says Linda Blumberg, a senior fellow in health policy at the Urban Institute. A study by her organization shows health care has become more affordable since the Affordable Care Act was implemented two years ago. Still, the research found, about 17 percent of adults in the U.S. continue to struggle to pay their medical bills.

"When we see higher deductibles, higher copays, higher coinsurance, higher out-of-pocket maximums on these insurance plans, the people who are most affected are those that have the most need for medical care," Blumberg says.

About 15 percent of those in NPR's poll say that at least once in the past two years, they couldn't get the health care they needed. And 58 percent of those said it was because they couldn't afford it.

Separately, 19 percent of poll respondents say they didn't fill a prescription because of the cost. Mary Lena Warden, 78, of Cleveland, Texas, is among them.

Warden lives alone and uses a wheelchair to get to the drugstore around the corner and to her doctor down the road. She pays $147 a month for Medicare, the government health insurance program for the elderly and the disabled. That's out of the $1,400 she gets each month in Social Security payments.

Warden says she doesn't qualify for extra help, like food stamps or Medicaid, the federal health care program for the poor.

"All my money is gone by the time I pay my rent, my gas, my lights, my water and my copay for the doctor," Warden says. "Everything else is gone."

Just two weeks ago, Warden skipped an appointment for an echocardiogram because she couldn't afford the $100 copay. And she is trying to decide whether to fill a prescription for a drug called Neurontin, which dulls the nerve pain in her leg — pain caused by a severe car accident. The last time she picked up the drug, her copay was $159.95.

"Right now I'm afraid to even buy medicines," Warden says. "I can't afford 'em."

Medicare, like more and more health plans, leaves lot of expenses for patients to cover, says Drew Altman, CEO of the Kaiser Family Foundation.

"The public perception may be that, because Medicare is so popular, it is gold-plated Cadillac coverage," Altman says. "But people who are on Medicare know that those costs can really bite."

Altman says Obamacare has given nearly everyone in the U.S. access to health care. About 89 percent of people now have insurance in some form, according to the Department of Health and Human Services.

But simply having insurance isn't always enough.

The next big challenge, Altman says, is to stop people from going broke when they get sick.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

KELLY MCEVERS, HOST:

Two years after the Affordable Care Act went into effect, about 90 percent of the U.S. population has some sort of health insurance - Medicare, Medicaid, an individual policy or an employer-sponsored plan. But a new poll from NPR, the Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health shows that people are still struggling to pay medical bills. NPR's Alison Kodjak reports that sometimes insurance isn't enough.

ALISON KODJAK, BYLINE: Barbara Radley can only reminisce about the work she did for almost 30 years.

BARBARA RADLEY: I drove semi. I held furniture. Yeah, it was nothing for me to throw a couch on my back and carry it up a flight of stairs.

KODJAK: Now she's 58. She lives in Oshkosh, Wis., and is disabled. She says she's got five herniated discs in her back. And on top of that, she suffers from diabetes, scleroderma, and her kidneys are failing. She and her husband - he's also mover - were doing okay between his pay and her disability payments. They made about $30,000 a year. Then, two years ago, they were hit with a double whammy. His company changed insurance to a new plan that cost about $700 a month with a $5,000 deductible. Then her husband needed emergency surgery and missed a few months of work.

RADLEY: The medical bills were just piling up. We just couldn't handle it. We couldn't keep up.

KODJAK: They moved out of their family home and rented a place from her daughter-in-law. They never eat out except when they head to their church for a free meal. Still, they ended up in bankruptcy early last year. That helped them get rid of their old medical debt, but the health problems didn't go away. Barbara's cost are constant, and her husband had another surgery last fall. In the last 12 months, they've racked up another $10,000 in unpaid medical bills.

RADLEY: You know, everybody wants your money, and it's like, well, stand in line. You know, you ain't going to get none.

KODJAK: NPR's new poll shows Radley has plenty of company. A quarter of the people we surveyed say medical bills have caused them serious financial problems in the last two years. Seven percent of that group filed for bankruptcy. Bradley now has to make Faustian bargains on a regular basis.

RADLEY: There's times I checked my blood for my insulin. And I know I only have two pens left, and I really can't afford it for another week and a half. Well, then I take a lower dose of my insulin. Otherwise, I'll just skip it.

KODJAK: Just yesterday, she was thinking about taking out a payday loan or selling something on Craigslist to cover the $450 co-pay for her insulin. Radley's family is one of millions who's out-of-pocket medical costs are rising. A study last year by the Kaiser Family Foundation shows premiums and deductibles have been growing far faster than worker's wages. Linda Blumberg, a senior fellow at the Urban Institute, says that hurts people who are really sick, like Barbara Radley.

LINDA BLUMBERG: When we see higher deductibles, higher copayments, higher coinsurance, higher out-of-pocket maximums on these insurance plans, the people who are most affected are those that have the most need for medical care.

KODJAK: About 15 percent of those who answered our poll questions said they couldn't get the health care they needed at least once in the last two years. More than half of those said it's because they couldn't afford it. And separately, about 20 percent of poll respondents said they didn't fill a prescription for the same reason. Mary Lee Warden is one of them. The 78-year-old lives in Cleveland, Texas. She uses a wheelchair to get to the drug store around the corner and to her doctor down the road. She pays $147 a month for Medicare, the government health insurance for the over-65 set. That's out of the $1,400 she gets each month from Social Security. She says she doesn't qualify for extra help like Medicaid or food stamps.

MARY LEE WARDEN: All my money's gone by the time I pay my rent, my gas, my lights, my water and my co-pay for the doctor. Everything else is gone.

KODJAK: Just two weeks ago, Warden skipped an appointment for an echocardiogram because she couldn't afford the $100 co-pay. And she hesitates to fill her prescription to ease nerve pain in her leg caused by a serious car accident. The co-pay last time was about $150.

WARDEN: Right now, I'm afraid to even buy medicine. I can't afford them.

KODJAK: Medicare, like more and more other health plans, leaves a lot of expenses for patients to cover, says Drew Altman of the Kaiser Family Foundation.

DREW ALTMAN: The public perception may be that because Medicare is so popular, that it is gold-plated Cadillac coverage. But people on Medicare know those out-of-pocket costs can really bite.

KODJAK: Altman says Obamacare has given nearly everyone in the U.S. access to healthcare. But having insurance isn't always enough. The next big challenge, he says, is to try to stop people from going broke when they get sick. Alison Kodjak, NPR News. Transcript provided by NPR, Copyright NPR.