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Medical debt is engulfing more people as pandemic takes its toll

"I wake up in the middle of the night thinking about it. I just can't believe it's come to this," said one woman with long-term Covid symptoms.
Illustration of a persons fist holding a single dollar bill as they drown in a pool shaped like a medical cross.
Medical debt has inevitably grown at a faster clip during the past year as the country faces a never-before-seen economic and labor crisis, experts say.Lehel Kovacs / for NBC News

Andréa Ceresa said she may have to declare bankruptcy soon. She has paid off about $23,000 in medical bills so far, but she faces $133,000 more for a nine-day hospital stay in November.

Since she contracted Covid-19 a year ago, Ceresa has joined the ranks of those who still struggle with various manifestations of the coronavirus. She's also one of a growing number of Americans who can't afford their medical bills.

While scientists continue to study the numerous ways people can get sick from Covid-19, Ceresa's symptoms, which have never abated, have run the gamut: from troubled breathing and low blood pressure to migraines, brain fog, rashes and more. Each symptom seems to come with another referral to another specialist, she said, and with it, another bill.

Like the many sick or ailing Americans who have taken on copious amounts of medical debt during the pandemic's economic crisis, Ceresa, a former dental office manager in New Jersey, hasn't been able to go back to work even as the bills pile up. Data collected by Credit Karma, a finance company, shows that the country's already large amount of medical debt spiked during the pandemic, affecting more people, likely because of the number of workers who lost their employee-sponsored health insurance.

Image: Andrea Ceresa
Andrea Ceresa.Courtesy Andrea Ceresa

Medical debt among Credit Karma's members spiked by $2.8 billion, or about 6.5 percent, from the end of May to the end of March. The number of people with past due medical debt grew by nearly 9 percent, from 19.6 million to 21.4 million.

Now bankruptcy is Ceresa's only option, she said. The $26,000 raised in her GoFundMe campaign has been spent on insurance premiums, doctors visits, lab tests and more.

"That's just what's going to have to happen," she said. "The choices were that I either lived or died. I wake up in the middle of the night thinking about it. I just can't believe it's come to this. That amount of money is ungodly."

A survey published last month by LendingTree found that 60 percent of Americans who were polled faced medical debt, with 53 percent saying the debt was greater than $5,000 and 72 percent saying it prevented them from pursuing key financial milestones, like buying a home or having a child.

Image: Kimberly Thomas
Kimberly Thomas.Courtesy Kimberly Thomas

Kimberly Thomas, 36, said she had worked on her credit score for the past four years, raising it by 200 points before the pandemic. Thomas, a mother of three, hopes to go back to college some day, but she said she has maxed out her credit cards trying to treat her long-term Covid-19 symptoms, which included seeing specialists and a speech therapist near her home in Michigan.

Thomas, a former church administrator, isn't able to work, and she said her family is struggling under the thousands of dollars of medical debt she has accrued.

"I'm trying to find some kind of insurance that I qualify for that will cover other tests or find a neurologist. I would really hope to find someone to help," she said, her speech coming slow and choppy. "But the realistic part of me says: 'Just stop. Don't make it more difficult. Pay off what you have. This is the life God has given you. Make the best of it.'"

A pandemic spike in debt

Medical debt has inevitably grown at a faster clip during the past year as the country faces a never-before-seen economic and labor crisis, experts say.

An estimated 7.7 million workers in America lost their employee-sponsored health insurance by June, which affected 6.9 million dependents, as well, according to an October study conducted by the Commonwealth Fund, the Employee Benefit Research Institute and the W.E. Upton Institute.

Matthew Eisenberg, an economist and professor at the Johns Hopkins Bloomberg School of Public Health, said medical debt is likely to have ballooned in the following months because of the loss of that coverage.

"Over the past year, there have really been three factors," Eisenberg said. "One is that many people lost their health insurance. Two is they lost their job — they had to take on a plan with a higher deductible if they could afford it, which exposes them to higher out-of-pocket costs. And then three is that if they lost their job, they have less disposable income, which makes any medical or emergency issue harder to weather financially."

The Affordable Care Act, known by many as Obamacare, has served as a stopgap for many people, especially after President Joe Biden opened a special enrollment period for them to sign up in February. That period lasts through August, and the administration reported last month that more than 500,000 had already signed up.

The $1.9 trillion pandemic bailout Congress passed this year, known as the American Rescue Plan, also provided additional subsidies to make many of the Obamacare plans considerably cheaper. The Department of Health and Human Services projected last month that 6.8 million people can now buy plans on, the Obamacare marketplace, with no monthly premium.

The cost protections expire in less than two years, however, and a debate on Capitol Hill is already brewing over their future.

Mark Rukavina, the director of Community Catalyst’s Community Benefit and Economic Sustainability Project, a left-leaning health care advocacy group, emphasized that the Biden administration has pushed the needle by encouraging the expansion of health care coverage and providing other consumer protections in the wake of the pandemic through the American Rescue Plan. But there is still work to be done to mitigate the effects medical debt can have on people's lives, he said.

"There has been some effort to help prevent people from incurring medical debt over the past year," said Rukavina, who has focused his efforts on issues of medical and hospital debt. "But, despite that, people still did."

Relief from Congress?

In recent years, lawmakers in Congress and in statehouses across the country have considered legislation that would address health care costs, the amount of medical debt accrued by people and how health care providers can collect that debt.

Democrats have redoubled their efforts in light of the pandemic.

Sens. Chris Van Hollen, D-Md., Jeff Merkley, D-Ore., and Sherrod Brown, D-Ohio, introduced a bill focused just on the debt incurred during the pandemic. The bill would in essence suspend the collection of past due debt and the interest accrued on it from Feb. 1, 2020, until the end of the public health emergency. It would affect all health care providers who have accepted or applied for federal relief during that time. The bill hasn't moved since it was introduced in the Senate.

Rep. Katie Porter, D-Calif., introduced a bill in February to limit the effects of medical debt on people's credit. It's the second time she has brought the bill to the House.

IMAGE: Rep. Katie Porter, D-Calif.
Rep. Katie Porter, D-Calif., holds up a board outlining the cost of coronavirus testing during a House Oversight Committee hearing on Capitol Hill on March 12.Sarah Silbiger / Bloomberg via Getty Images file

Porter said medical debts aren't created because of a person's fiscal responsibility, so they don't reflect a person's creditworthiness. The bills pile up as a person seeks treatments, operations, drugs and doctors visits for a health issue they're trying to live through or even survive — it isn't a fair measure of them as a financial risk.

"This bill is not a panacea to the larger issues of how we fund our health care system," she said. "But it definitely takes aim at one of the actors, which is credit reporting agencies, who are turning literally life-and-death matters into a source of sales."

Porter said the best chance to pass the bill would be with bipartisan support. But a Congress with tighter voting margins has only made legislating slower, she said.

"I had a Republican co-sponsor last time," Porter said, referring to the last Congress in which she introduced the bill. "Ironically, even though there are more Republicans in the House now, it's gotten harder to find co-sponsors."

'A very, very hard road'

Although more American workers may now face medical debt because of the economic climate caused by the pandemic, patients in the U.S. have long faced health care costs they can't afford.

Carol Voytko, 48, has breast cancer that has spread to her bones, which weaken and are more prone to breaks as the disease progresses. Voytko, a former health care worker who lives in rural Pennsylvania, is on disability, and the bills she and her husband get in the mail and the collection calls they receive throughout the day have haunted their lives for the past eight years. The medications, operations to insert metal rods to support her bones, radiation and chemotherapy treatments have left them more than $500,000 in debt.

Image: Carol Voytko
Carol Voytko.Courtesy Carol Voytko

That's only a piece of the full cost of her treatment, said Voytko, who has to continue chemotherapy "until the cancer finally gets me." Her insurance covers about 80 percent of her bills, but the financial battle Voytko said she has to fight to receive treatments and limit the full economic shock is a massive undertaking. It also comes with a huge psychological weight and a feeling that her value is based on what she can afford, she said.

"It's a very, very hard road, and I wouldn't wish this on anyone," Voytko said. "You're trying to keep your household together, you're trying to stay positive for people around you and people you care about, and the hospital or the insurance company tells you, 'We're only going to pay this amount of money for you. You're responsible for the rest, and we don't care how you pay for it or who it affects.'"

That's a feeling reiterated by Thomas and Ceresa. The passage of time seems to bring few answers and only more bills for them to pay. It takes an immeasurable toll.

While the three women said they have some hopes for the future, all said they fear that their lives and their medical debts are becoming unceasing burdens to their families.

"In my darkest moments, I've wished I'd died instead of dealing with all this," said Thomas, whose words grew more laborious as she began to cry. "It's not fair for my family to deal with it. I'm glad I'm here now, but I just want people to realize that I didn't choose to get sick or sick for this long."