Medical debt is affecting the mental, physical and financial health of Missourians, according to a report from the nonprofit Missouri Foundation for Health.
The St. Louis-based organization late last year convened dozens of people across eight focus groups to ask them about how medical debt had affected their finances, families and job prospects. People across demographics said they delayed health care and ignored health problems to deal with debt.
They also reported the debt caused stress, shame and family strain.
“It's a system where even insured folks struggle,” said Samantha Schrage Bunk, a health policy analyst at the foundation. “Avoiding care due to cost does harm everyone in the long run with more serious, expensive health issues. Our focus groups show high costs are preventing people from getting care.”
The eight groups included two groups each of Spanish Speakers, people with low incomes, rural residents and those with disabilities.
Schrage Bunk said the foundation aims to follow up the initial conversations with a more in-depth study.
Despite having different lived experiences, many had similar difficulties with their debt, she said. They described taking on additional work, forgoing additional health care procedures because they didn’t want to take on more payments, and diverting car payments, retirement funds or other expenses to pay for medical debt.
Medical debt also causes emotional distress, the report found.
“I would say it has caused depression,” one woman in the Spanish-speaking group, who had between $1,000 and $2,500 in medical debt, told the researchers. “It’s horrible to see the money you earn isn’t yours. You kill yourself working and, at the end of the day, your whole paycheck goes to your debts. I’ve fallen into depression a lot because of that.”
Many interviewees said the debt affected their credit score, which kept them from getting a house or vehicle to get to work, the report noted.
People in the focus groups described taking on debt for planned and unplanned procedures, the report’s authors said. But even planned procedures could result in unexpected bills, as when a patient receives bills from multiple providers for a single procedure or when a clinic makes an administrative error, Schrage Bunk said.
“You go to the hospital and you're expecting, you know, one or two bills when you come out,” she said. “But you might get a bill from four or five different places and are not sure what was covered if you are insured, or what wasn't covered.”
According to an analysis of Census data by the health policy research organization KFF, 10.6% of Missourians, or around 500,000 residents, carry some medical debt in a given year. The KFF report states that is “not statistically different” from the national average of 8.6%.
Focus group members said they’d like to see better communication from providers about how much care would cost before procedures happened.
A 2022 federal law called the No Surprises Act included provisions aimed to cut down on surprise billing and out-of-network providers charging sky-high costs for care at in-network locations. Consistent costs for procedures would also make it easier to plan financially for medical care, they said.
Missourians also want more comprehensive insurance coverage, especially from non-Medicaid plans, lower deductibles and opportunities for debt forgiveness, the report found.
The coronavirus pandemic upended many people’s expenses as residents lost jobs and related health coverage, said St. Louis Alderman Rasheen Aldridge, a Democrat, whose ward stretches along the riverfront from downtown to the north side.
“Now they’ve got these bills, and it’s on their name,” Aldridge said. ‘It’s so much trauma that we know the pandemic has left behind – physical and mental trauma, but also financial trauma on people’s ability to succeed.”
Aldridge has introduced a bill that would use American Rescue Plan dollars to forgive the medical debt of St. Louis residents. He said other cities have used the funds in similar ways.
The bill would reappropriate $800,000 originally set aside for the city’s Reproductive Equity Fund, which aldermen passed in 2022 to provide child care, transportation and other logistical support for people seeking abortions.
“I haven’t seen pushback,” he said. “If you're on the north or south side, a lot of people just don’t have insurance, and this is a direct way to be able to help people.”
Local officials in Ohio and Illinois have used millions of dollars in pandemic funds to help people pay down their debt.
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