From her point of view, the Knoxville health care system “isn’t designed for poor people”

“I don’t buy a lot of food. Plain and simple.’

Monica Reed

Monica Reed, 60, Knoxville, Tennessee.

Estimated Medical Debt: 10,000 dollars

Medical problem: Crab

What happened: Monica Reed considers herself luckier than most. Born in Knoxville and raised by a single mother, Reed became the first in his family to own a home, a small house built after the city demolished The Bottom, a once-thriving black neighborhood that was systematically obliterated in a mid-century urban renewal campaign . For the past 15 years, Reed has worked for a faith-based nonprofit that assists low-income Knoxville residents.

“It hasn’t always been easy,” Reed said. She raised her son alone. And although she has always worked, her modest salary makes it difficult to save. “I just tried to live a frugal life,” she said. “And by God’s grace I didn’t end up homeless.”

However, she could not escape the medical debt. Diagnosed with cancer five years ago, Reed underwent surgery and chemotherapy. Although she had health insurance through work, she was left with nearly $10,000 in medical bills she couldn’t pay.

What’s broken: In and around Knoxville, residents of predominantly black neighborhoods are more than twice as likely to owe money on medical bills as those in predominantly white neighborhoods, data from the Urban Institute credit bureau show. This is one of the largest racial disparities in the country.

Health care debt in the US now affects more than 100 million people, according to a national study KFF conducted for this project. The charges are particularly high for black communities: Fifty-six percent of black adults owe money on medical or dental bills, compared to 37% of white adults.

The explanation for this startling disparity is deep-rooted. Decades of discrimination in housing, employment and health care have blocked generations of black families from building wealth — savings and assets that are increasingly critical to accessing America’s expensive medical system.

Against this background, patients suffer. People with debt avoid seeking care and become sicker with treatable chronic conditions such as diabetes or multiple sclerosis. Worse still, hospitals and doctors sometimes won’t accept patients with medical obligations – even those who are undergoing treatment.

Nationally, black seniors who had health care debt were twice as likely to say they were denied care because they owed money than white seniors with such debt, the KFF study found. Many black Americans also split their care due to fear of cost.

If black patients go into debt, they face another challenge: a medical debt collection industry that targets black debtors more aggressively than their white counterparts, especially for smaller debts.

What’s left: Reed has been hounded by debt collectors and even taken to court. This forced Reid to make tough choices. “There are always casualties,” she said. “You’re just doing without some things to pay for other things.”

Reid said she has cut back on trips to the grocery store: “I don’t buy a lot of food. Plain and simple.’

She has adjusted, she said. “You just do what you have to do.” What angers Reid, however, is how she’s been treated by the cancer center, where she goes for periodic checkups to make sure the cancer remains in remission. When she tried to make an appointment recently, a financial advisor told her she couldn’t schedule it until she made a plan to pay her bills.

“I was so upset I didn’t even realize how much I owed,” Reid said. “I mean, I wasn’t calling about a little toothache. It’s something that affects someone’s life.”

Reid said she tries to stay optimistic. “I don’t worry about the little things,” she said. “What am I going to do against this hospital?

But, she said, she has realized one thing about the nation’s health care system: “It’s not designed for poor people.”

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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