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Half of all U.S. adults are “extremely concerned” or “concerned” about bankruptcy resulting from medical costs associated with a major health event, according to a Gallup report published Sept. 1.

This is a five-point increase from 2019, with female concern increasing 4 points and male concern by 7 points. While white adults only saw a 2-point rise in concern from 2019 to 2020, non-white adults saw a 12-point increase.

Young adults (18-29) had the highest increase at 12 points, followed by respondents aged 30-49 (9-point increase) and 65-plus (2-point increase). Adults between 50 and 64 saw a 4-point decrease.

A total of 15% of U.S. adults report having medical debt in their household that cannot be repaid in the next year.

Non-white adults (20%) were more likely than white adults (12%) to have such debt, while those with a household income of $40,000 or less (28%) were nearly five-times as likely as those households earning $100,000 or more (6%) to have medical debt.

Around a quarter (26%) of respondents said they would have to borrow money to pay a $500 medical expense.

By comparison, 54% would pull money from personal checking or savings and 14% would use a medical flexible-spending account or health savings account.

Non-white respondents (43%) were more than twice as likely as white respondents (17%) to say they would need to borrow money to pay a $500 medical bill, while those households with annual income of $40,000 or less (46%) were nearly six times as likely as those making $100,000 or more to need to borrow funds.

The overall margin of error for the survey was plus-or-minus 3.9%.

The full report is available here.

I reached out to several faith leaders, asking them to comment on the report and to share their personal experiences and insights.

“Access to health care is a fundamental human right,” Autumn Lockett said before sharing her family’s recent experience. “I do not believe health care should be tied to employment. This pandemic has proven that to be especially true.”

“My husband unexpectedly lost his job in March. Thankfully, we were able to continue health insurance for our family of six through COBRA, though at quite an expense (about the same as our mortgage),” explained Lockett, executive director for development and marketing at Good Faith Media.

“Recently, my husband started a new job and our family coverage began Sept. 1. Though we have coverage, we don’t have ID numbers yet. As medical necessity would have it, our son who has epilepsy required extensive tests on his brain and heart the first weekend in September. He also required a refill on his anti-seizure medication,” she said.

“The testing is thousands of dollars, which we’ll have to pay and await (hopeful) reimbursement from insurance. The anti-seizure meds cost about $100 for four days of dosing,” Lockett said. “The stress of medical procedures and caring for a child with tricky special needs is unnecessarily compounded by the financial burden of health care costs.”

“I share this vulnerable moment for our family in hopes that you’ll see a dimpled face of a kid who needs access to health care instead of a faceless liberal socialist,” she said. “I want the same access for you and your babies.”

“Frequently as a hospital chaplain and clinical ethicist, I visit with chronically ill patients who share with me their fears over how to pay for continued care,” said Monty Self, a certified health care ethics consultant and senior staff chaplain at the Baptist Health Medical Center in Little Rock, Arkansas.

“The saddest cases are terminally ill patients who have worked their whole lives and should be focusing upon spending their last moments with family, but they are plagued with fear over how their loved ones will survive, let alone pay for mounting medical bills,” he said.

“This parallels a 2019 article published in The American Journal of Public Health, which documented that around two-thirds of Americans who file for bankruptcy cited major medical issues or medical debt as a primary reason. This is coupled with the fact that less than half of Americans have $1,000 in saving that they could use to cover a health care emergency.”

“In some cases, the burden of rising health care debt contributes to these patients’ rapid decline,” Self observed. “It is sad that in the most affluent country in the world, the cost of health care is still killing us.”

Guy Sayles is a now-retired pastor who serves as a consultant for the Center for Healthy Churches and blogs at From The Intersection. He was diagnosed in early 2014 with multiple myeloma.

“I’m fortunate that I’m able to buy health insurance coverage through my wife’s employer. While the premium is steep, it does stand as a buffer between us and the threat of bankruptcy,” he said. “Even with health insurance, though, the gap between what insurance will pay and what health providers and drug companies charge is significant, especially for the cost of chemotherapy drugs on which I’m dependent. Covering that gap is a financial strain.”

“Two realities keep me unsettled about the possibility of bankruptcy or of accumulating a mountain of medical debt. One is the connection between employment and health insurance,” Sayles said.

“While there are plans available for people who are unemployed or self-employed on exchange created by the Affordable Care Act, the deductibles are often very high and, therefore, out-of-pocket expenses are essentially unmanageable. In this climate of economic uncertainty, I worry that unemployment could result in coverage that would make it nearly impossible to meet the costs of medical care.”

“A second factor is the ongoing threat to end the mandate, which requires insurance companies to cover preexisting conditions,” he said. “Without that provision, I would face stark choices of either deferring medical care or putting my finances in serious jeopardy.”

As a diabetic, Elmo Familiarian carefully planned his retirement in December 2018 around his prescription needs and anticipated medical expenses.

He and his wife researched insurance premiums before his Medicare would start, and they set aside funds to cover these expenses. All went according to plan until his supplemental prescription plan on Medicare began.

“Then some hard realities hit me,” said Familiarian, who spent 39 years in congregational, ecumenical, clinical pastoral, national and regional ministry with the American Baptist Churches USA.

“I learned more about the ‘contracts’ that drug manufacturers have with pharmacies, primarily how uneven they are. I also learned that my prescription plan provides an ‘allowance’ – which turns out to be really a cost threshold – that, when exceeded, will mean that my copay will increase to 50% of the actual cost of the drug!”

As a result, the medication recommended by his endocrinologist would now cost him $150 for a 30-day supply, something he could not afford long-term. So, Familiaran is working with his doctor on alternative options, including non-prescription means for addressing his diabetes.

The Gallup report is “a foreboding reality that I never imagined will apply to me. Now it does,” Familiaran said.

“Clearly, the certitude of adequate and affordable health care is only assured to the select wealthy among us. … Our system of private, employee-tethered health insurance coverage is like a sword of Damocles hanging over the heads of the vast majority of Americans. And for the unemployed, they are bereft. … It must be reformed, and courageous public policy must lead the way.”

For Tarris Rosell’s family, “never buy what you can’t afford” was the mantra adopted after his grandparents lost their farms during the Great Depression due to unpayable debts.

His parents committed not to incur debt for cars, farms or anything else – a plan that came to an impasse over health care expenses.

“My Depression-era father could not live without expensive cancer and cardiology care when he needed it. And there were no cheaper options,” said Rosell, who is professor of pastoral theology-ethics and ministry praxis at Central Seminary in Shawnee, Kansas.

“In health care emergencies, there is no Ford instead of a Lexus. It’s all Lexus. Or Lamborghini. Thank God, my dad had Medicare. Thank God, I have employer-provided insurance.”

“Of what am I reminded when reading this Gallup report?” he asked. “That Depression-era wisdom applicable to car-buying doesn’t work when it comes to health care – or only if one is very lucky. Surely in this nation we can and should depend on something other than luck. Shouldn’t we?”

“This mess is our fault. As a people, we have sinned. And individuals like my father and I who have thus far escaped the consequences of our national sin are indeed lucky while others are not,” Rosell said.

“But even for those most fortunate and privileged, luck has a way of running out. If only as a matter of self-interest when it comes to health care costs, we all ought to be ‘concerned or extremely concerned.’”

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