National Edition

1 in 4 Americans struggle to pay doctor bills

Published: Wednesday, Feb. 12 2014 4:00 a.m. MST

One quarter of Americans say that health care bills are a financial burden, or that they can't afford to pay them at all.

Kiichiro Sato, AP

Millions of Americans are skipping medical care because they can't afford to go to the doctor. About one in four Americans say they are struggling to pay health care costs — or can't afford to pay them at all, according to a study from the CDC.

Anyone who has made a trip to the emergency room recently isn’t surprised by this news. Getting stitches or a splint can cost two months’ rent, and for a family of four, the cost of medical care for a year now costs more than a year’s worth of groceries to feed them, according to the Milliman Medical Index. Soaring costs mean that people are skimping on everything from preventative check-ups to immunizations to prescription medications.

Got insurance? For many families, that still doesn't mean they can afford to see the doctor. High deductibles can be so burdensome that 21 percent of insured families said that medical bills are a hardship. Not surprisingly, the uninsured fared the worst, with 40 percent saying that they struggled to pay for care.

Have job but can't afford doctor

Many Americans skip going to the doctor to save money — around 30 percent of people, according to a Gallup poll.

Jeanine Gergel is assistant executive director at North Coast Health Ministry just outside Cleveland, where manufacturing used to be strong but has dried up. Now, many residents are unemployed or have taken lower-paying jobs and don’t get benefits.

“There’s a myth about the uninsured that they are unemployed,” says Gergel. “Most of our clients have jobs — many of them have two or three jobs.” The problem, she says, is that especially in the wake of the recession, people have taken part-time jobs to get by, which usually don’t provide health insurance.

Gergel says those who can’t afford insurance in her community range from construction workers to former mortgage brokers to laid-off teachers to child-care workers and home health aides.

Some of the hardest hit are those who are aging but don’t yet qualify for Medicare. The typical patient they see is someone who is 50-plus who was downsized or lost their job and can't find good work, says Gergel. Health problems and health care are top financial concerns for those approaching retirement — even wealthier Americans who have more than $250,000 in assets reported that health care expenses were their most pressing retirement expense, according to a new study commissioned by Bank of America Corp’s Merrill Lynch.

Pricing out the sick and poor

Americans pay much more for health care than other affluent countries, according to a Commonwealth Fund survey: Americans pay an average of $8,508 per person on health care — a full $3,000 per person more than the second-biggest spender, Norway. That's a price tag that many of the sick and poor can't afford.

About 37 percent of Americans spent more than $1,000 out of pocket in 2013 even if they did have insurance — and that's not including monthly premiums. The upshot is that sometimes even those with insurance can't afford a doctor.

Some of these people get by on emergency room visits in a crisis, but the chronically ill — those with heart disease, diabetes and other ailments that require frequent care — especially struggle.

Gail Basile's husband suffered a heart attack and was off work for four months when doctors decided that he needed a pacemaker. His company was wary of keeping him on at that point, so they helped him get on disability through the company, but it didn't cover the cost of hospital visits. "We used our savings, we used our 401(K), we used anything we had," says Basile, who was eventually able to find low-cost care through a privately funded clinic.

Skipping the doctor

Soaring costs mean that many people skip treatment. A Gallup poll found that three in 10 Americans forgo medical treatment due to high costs. Among the uninsured, three in five avoid treatment.

Ilene Halder's family immigrated to the U.S. from Bangladesh so that she could get an education. She's a student and her father works at McDonald's, which means that neither of them has insurance. "He doesn't make much pay and his health care isn't very good, and we can't even afford medications," says Halder.

The researchers from Gallup speculate that even insured Americans put off doctor visits because of the rising popularity of high-deductible plans that shift the cost from employers to workers and policyholders. The authors speculate that even insured people with serious conditions are putting off treatment because of a spike in out-of-pocket costs.

The Affordable Care Act will take some steps to address these issues, according to thinkprogress.org, by increasing insurance coverage for those who couldn't afford it and enacting consumer protections that help ensure that insurance companies don't gouge patients.

Still, the law has not significantly affected the cost for families covered by large employer-sponsored programs with high deductibles and out-of-pocket prices, according to Milliman Medical Index. It remains unclear how reform will — or will not — provide relief for those families.

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