Every time one of Heidi Hendrix’s four kids has a health issue, she has to work out an agonizing equation.
“A lot of times I have to decide, is it really important enough for us to see a doctor?” Hendrix said. “Because for us, it sometimes comes down to, ‘Do I spend $200 for him to see a foot doctor or do I use that $200 to buy groceries?’ ”
Hendrix is a stay-at-home mom in Independence. Her husband is a plumber and the family has health insurance through him. It’s a union job, so the insurance is actually pretty good, she said. But with a $5,000 deductible, the family has had medical bills that it just can’t pay all at once and has had medical providers turn them over to collections agencies.
The Hendrix family is far from alone. A county-by-county study published this month by the nonprofit Urban Institute found that in some parts of the Kansas City area, almost one in three households has medical debt in collections.
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In Jackson County, it’s 29 percent. In Wyandotte County, it’s 31 percent, the highest in the metro area.
That’s thousands of families like the Hendrixes that have to make tough decisions and entire communities with credit scores decimated by illness or injury.
“For our folks it could be the difference in whether or not they’re able to get a car, an apartment or a loan for a new home,” said Jerry Jones, the executive director of the Community Health Council of Wyandotte County. “This medical debt could present barriers to advancing in life.”
The persistence of medical debt is something lawmakers will have to address after they’ve finished haggling over the Affordable Care Act — the 2010 health insurance law commonly called Obamacare that Democrats want to shore up and most Republicans want to repeal.
More Americans are insured since the law passed and there’s some evidence that the law reduced bankruptcies due to catastrophic medical costs.
But for most Kansas City residents, it’s relatively routine medical bills that put them in collections, not five-figure debts for things like surgeries or extended hospitalizations.
The Urban Institute’s study found that the median medical debt in collections was $731 for Jackson County residents and $690 for Wyandotte County residents.
That’s in line with a national Kaiser Health Tracking poll published in March, in which 45 percent of respondents said they would struggle to pay a surprise medical bill if it was more than $500, and would have to either put it on a credit card, borrow money to pay it or not be able to pay it at all.
The Urban Institute based its study on a random sample of unidentified, consumer-level 2016 records from a major credit bureau and the U.S. Census Bureau’s American Community Survey.
Wyandotte County’s rate of medical debt was the highest in Kansas, just ahead of Seward County and Stevens County in the southwest corner of the state. In neighboring Johnson County, it was 14 percent.
In Missouri the highest rates were in the southeastern part of the state, led by Pemiscot County at 47 percent. Bates County led the western half of the state at 30 percent, while Cass County (25 percent), Clay County (17 percent) and Platte County (16 percent) were all lower than Jackson County.
Caroline Ratcliffe, one of the Urban Institute’s researchers, said she and her colleagues have found that the amount of other types of debt in collections is declining as the economy recovers from the Great Recession. But the level of medical debt is not. It’s stable.
“Delinquent medical debt is pervasive and really threads through all communities,” Ratcliffe said.
Ratcliffe said the reason may rest in the rising deductibles that families have to pay each year before their health coverage even kicks in.
An analysis by the Peterson Center on Healthcare and the Kaiser Family Foundation found that the average deductible for an individual with employer-based health insurance rose from $303 to $1,505 between 2006 and 2017. In most plans, it’s much higher for families.
The analysts noted that as average deductibles have risen, wages have not kept pace, increasing the percentage of income families spend on out-of-pocket medical care.
For families like the Hendrixes, in which all four kids have asthma, it’s almost impossible to avoid paying out that entire deductible every year.
“For normal people, a little cold won’t send them to the hospital,” Hendrix said. “But for us, if somebody can’t catch their breath or it’s affecting breathing, we’re at the hospital no matter what.”
Jones said hospitals should work with patients on no-interest payment plans or be willing to write off some costs. Nonprofit hospitals are required to offer some free or reduced-price charity care in exchange for their tax-exempt status, but a University of Michigan study found that more than half haven’t been notifying patients they might be eligible for it before trying to collect unpaid bills.
“My hope would be they’re not really aggressively seeking payment without first considering what their charity care policy might be,” Jones said. “I am always interested in knowing, ‘How much do patients know about charity care prior to seeking services?’”
Hendrix said some hospitals and clinics have been willing to work with her on payments, but others have taken a hard line and sent them to collections.
They would also like to move, but they can’t get a home loan until they pay off the medical debt, repair their credit and get the collections agencies off their backs.
“It’s pretty much constant nagging,” Hendrix said. “I’ve also learned a lot in the past 15 years. ... If you tell them you’re going to pay and then you don’t pay, they come after you even harder and it affects your credit even more.”