A retiree returns to work after a disastrous year of emergency health issues

“My stress was off the charts.”

David Ziprich

David Ziprich, 65, Fort Worth, Texas

Estimated Medical Debt: More than $200,000

Medical problem: Diabetes and covid-19

What happened: David Ziprich, a Fort Worth businessman and grandfather, was forced to retire after a series of hospitalizations left him more than $200,000 in debt.

Zipprich has spent a career in financial consulting. He owned a small bungalow in a historic district near the Fort Worth train stations. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings and had paid off his mortgage.

In early 2020, however, Zipprich landed in the hospital. While driving, his blood sugar plummeted and he passed out and crashed his car.

Three months later, after being diagnosed with diabetes, another complication landed him back in the hospital. In December 2020, covid-19 put it there again. “I look back on that year and feel lucky that I even survived,” Ziprich said.

What’s broken: Of the 20 most populous counties in the country, none has a higher prevalence of medical debt than Tarrant County, where Fort Worth is located. In second place is neighboring Dallas County, credit bureau data show.

Nevertheless, the Dallas-Fort Worth medical systems are thriving. Although many are tax-exempt as nonprofits, several have posted double-digit profit margins in recent years, outpacing many of the area’s Fortune 500 companies.

A KHN review of hospital finances in 306 hospital markets across the country found that several of the most profitable markets also have some of the highest levels of patient debt.

Overall, about one-third of the 100 million U.S. adults with health care obligations owe money for hospitalization, according to research conducted by KFF for this project. About a quarter of them owe $10,000 or more.

“The fact is, if you walk into a hospital today, chances are you’re going to walk out with debt, even if you have insurance,” said Alison Sesso, CEO of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors , so patients don’t have to pay for it.

In Tarrant County overall, 27 percent of residents with credit reports have medical liens on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute show. In Dallas County, it’s 22.5%

What’s left: Even with insurance, Zipprich was overwhelmed with medical bills, debt notices and calls from debt collectors.

As he struggled to make payments, his credit score dropped below 600 and he had to refinance his home. “My stress was off the charts,” he said, sitting in his tidy living room with his Shih Tzu, Murphy.

Last year, Zipprich went back to work, taking a job in New Jersey that required him to travel back and forth to Texas. He recently quit, citing the strain of traveling so much. He is looking for work again. “I never thought this would happen to me,” he said.

About this project

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

The series is based on the KFF Healthcare Debt Survey, a survey designed and analyzed by KFF public opinion researchers in collaboration with KHN journalists and editors. The survey was conducted from February 25 to March 20, 2022, online and by telephone, in English and Spanish, among a nationally representative sample of 2,375 US adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the last 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 bureaus and other demographic data on poverty, race and health status to examine where medical debt is concentrated in the US and what factors are associated with high levels of debt.

The JPMorgan Chase Institute analyzed records from a sample of Chase credit cardholders to see how customers’ balances might be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; talks to doctors, health industry leaders, consumer advocates, debt lawyers and researchers; and reviewed results from studies and surveys on medical debt.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of the KFF (Family Kaiser Foundation). KFF is a charitable, non-profit organization providing information on health issues to the nation.

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