Higher Bills Are Leading Americans to Delay Medical Care

Megan Swanson has warily watched the erosion of her family’s savings as inflation chips away at a reserve for emergencies.

She often postpones any regular doctor’s appointments, including her yearly dermatology appointment, even though annual skin checks are typically recommended for residents of sunny Florida, where she lives in Naples with her husband and their three children.

“Each month we are seeing our costs go up, but not our bank account,” she said.

Ms. Swanson, 37, is a part-time student and has not worked since she was laid off during the pandemic when the local Nordstrom store closed in 2020. Her husband, Brett, 37, is employed as the director of wellness at a retirement community.

“I put the priority on the kids,” she said.

Last March, the Swansons had to come up with $8,000 to cover their share of hospital bills after their baby daughter was hospitalized with a febrile seizure. “What if something happens again in the future, and how will we afford it?” she asked.

Rising out-of-pocket costs are weighing heavily on the scale, pushing aside tests or procedures when troublesome symptoms emerge. And these days, the grocery list (and even the price of eggs) feel more pressing to many families. While some people avoided seeking medical care during the worst of the pandemic, worried about the risk of infection or unable to get an appointment because hospitals and doctors were overwhelmed, now many are finding that inflation and the uncertain economy have thrown up another barrier.

“We are starting to see some individuals who are putting off some care, especially preventive care, due to the costs,” said Dr. Tochi Iroku-Malize, the president of the American Academy of Family Physicians and the chair of family medicine for Northwell Health in New York. Choosing between going to the doctor or paying for rent and food, “the health issue is no longer the priority,” she said.

The inability to afford medical tests and treatment, a perennial concern in the United States, began emerging as a much more striking issue last year. Nearly four of 10 Americans said they had put off care in 2022 because of cost, the highest number since Gallup started asking people about delaying care more than 20 years ago. The percentage reporting they or a family member delayed health care because of cost rose to 38 percent from 26 percent in 2021.

With the prices of prescription drugs, hospital stays and other treatments expected to increase significantly this year and next, some doctors expect families to have an even harder time affording medical care. A recent report from the Commonwealth Fund found that 29 percent of people with employer-based coverage were underinsured, because they had such high out-of-pocket costs even with insurance. The coming roll back of health coverage under the state-federal Medicaid program will very likely lead many people to become uninsured.

About one-fourth of respondents in Gallup’s poll said they put off care last year for what they considered a “serious” condition. When Margaret Bell, 71, found that her cancer had returned four years ago, she hesitated to resume her chemotherapy because she could not afford it, and higher prices have made it even harder. She would regularly skip appointments near her home in Lancaster, S.C.

“It is impacting patients’ access to care,” Ms. Bell’s oncologist, Dr. Kashyap B. Patel, said. As the chief executive of Carolina Blood and Cancer Care Associates in Rock Hill, S.C., he recently set up a nonprofit group, No One Left Alone, to help cancer patients like Ms. Bell and to connect them with local charities. The organization is covering the cost of her treatments, and Dr. Patel has assured her that his office will find the money for her visits.

On a limited budget, “it’s been very difficult for me,” Ms. Bell said. Having her family over for dinner can be a strain because of high grocery bills, and she is faced with deciding which of her medical needs is the most urgent. She has postponed receiving a pacemaker.

A new federal report suggests fewer Americans’ health bills are being sent to collection, but medical debt still accounts for more than half of all kinds of collection debt, exceeding unpaid credit card or cellphone bills. It remains a serious issue: about a fifth of Californians said they had medical debt of at least $5,000, according to another recent survey. A little over half of those asked said they had skipped some kind of care in the last year, with half of those reporting their condition got worse as a result.

“This is about trade-offs that people have to think about that are really hard,” said Dr. Jay Bhatt, the executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm. He also sees patients at the Family Christian Health Center outside of Chicago. In a survey by Deloitte last year, 28 percent of respondents said they were less able to afford care than in the previous year.

Some of the clinic’s patients are losing their jobs and insurance, he said. “We’ve seen this before, and we are going to see it in big numbers now,” Dr. Bhatt said.

In Hammond, Ind., Tameaka Smith and her husband, Stevenson Lloyd, are coping with tighter finances and trying to save where they can. She is disabled and covered through Medicare, the federal insurance program, while her husband, who works at an auto parts factory, has private insurance through his employer.

Still, they are skimping a bit on medicines they need. Her husband takes his thyroid medication every other day, and she sometimes uses her father’s asthma medicine. “We’re self-medicating, trying to stretch it out and doctor ourselves,” Ms. Smith said.

With two children, their family has not recovered from the financial strains of the pandemic. “It’s hard catching up when you’re so pushed back,” Ms. Smith said.

Her husband also weighs the merits of going to the doctor, knowing that if he doesn’t have to pay right away during the visit, “then next month we’re getting a big bill,” she said.

Any turbulence in the economy has historically resulted in the loss of medical care for an increasing number of people, either because they no longer have health insurance or because they cannot afford their share of medical bills. During the Great Recession, millions of Americans lost their health coverage, and many people are predicting a similar wave in the coming months. Millions of people could lose Medicaid coverage as states begin the process of dropping individuals from the program now that states will no longer have to keep people enrolled and extra federal funds are going to disappear.

The cost of treatments is also likely to rise next year as hospitals, many of whom reported losses in 2022, will raise their rates, said Sean Duffy, the co-founder and chief executive of Omada Health, a company in San Francisco that provides virtual care and coaching to people with chronic health conditions like diabetes. The company’s employees were already starting to see an increase in patients wrestling with how to pay for medicine and healthy food.

“2024 is the reckoning, unfortunately,” Mr. Duffy said.

In addition to medical bills, patients often cannot afford to take off work for a doctor’s visit, let alone find the funds to cover child care or the transportation needed to get there. A colonoscopy to determine why a patient may be bleeding could result in missing a day’s work and a medical bill equal to a week’s work, said Dr. Rajeev Jain, a gastroenterologist at Texas Digestive Disease Consultants. “We’re seeing an uptick in patients canceling for those reasons,” he said.

“You have a finite number of dollars to spend on your family,” Dr. Jain said. When you’re worried about having enough food or stable housing, “at that moment, you’re not thinking of preventing something five years from now.”

In 2021, a fifth of Americans either delayed or went without medical care because of the pandemic because of a lack of available appointments and fear of infection, according to a recent analysis by KFF, a nonprofit research group. Only 5 percent cited cost alone.

The catch-up in visits and procedures by people who are now able to see the doctor and the increased number of people seeking care caused by the winter season’s respiratory illnesses could mask any recent declines in seeking out medical care.

“It’s possible that this is the calm before the storm, especially since a lot of people are going to lose Medicaid coverage,” Cynthia Cox, a vice president at K.F.F., said.

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