Megan Swanson warily watched her family’s savings erode as inflation eroded a reserve for emergencies.
She often postpones her regular doctor’s appointments, including her annual dermatology appointment, even though annual skin exams are generally recommended for residents of sunny Florida, where she lives in Naples with her husband and their three children. .
“Every month we see our costs increase, 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 a wellness director at a retreat. community.
“I put the children first,” she says.
Last March, the Swansons had to come up with $8,000 to cover their share of hospital bills after their little girl was hospitalized with a febrile seizure. “What if something happens again in the future, and how are we going to afford it?” ” she asked.
Increased out-of-pocket costs weigh heavily, sidelining tests or procedures when bothersome symptoms appear. And these days, the grocery list (and even the price of eggs) seems more pressing for many families. Although some people avoided seeing a doctor during the height of the pandemic, worrying about the risk of infection or impossible to get an appointment Because hospitals and doctors were overwhelmed, many now find that inflation and economic uncertainty have thrown up another obstacle.
“We’re starting to see some people delaying certain care, especially preventative care, because of cost,” said Dr. Tochi Iroku-Malize, president of the American Academy of Family Physicians and chair of Northwell Family Medicine. Health in New York. Between going to the doctor or paying rent and food, “the issue of health is no longer the priority,” she says.
The inability to afford medical tests and treatments, a perennial concern in the United States, began to become a much more striking problem last year. Nearly four in ten Americans reported delaying care 2022 because of the cost, the highest number since Gallup began asking people about delaying care more than 20 years ago. The percentage reporting that they or a family member delayed health care due to cost increased to 38 percent, up from 26 percent in 2021.
With prices for prescription drugs, hospital stays and other treatments expected to rise significantly this year and next, some doctors expect families to have an even harder time affording medical care. A recent report of the Commonwealth Fund found that 29 percent of people with employer coverage were underinsured because they faced very high out-of-pocket costs even with insurance. The upcoming reduction in health coverage under the federal-state Medicaid program will very likely result in many people becoming uninsured.
About a quarter of those surveyed in the Gallup poll said they postponed care last year for what they considered a “serious” illness. When Margaret Bell, 71, discovered her cancer had returned four years ago, she was reluctant to restart chemotherapy because she couldn’t afford it and the higher prices made it even more difficult. difficult. She regularly skipped appointments near her home in Lancaster, South Carolina.
“This impacts patient access to care,” said Ms. Bell’s oncologist, Dr. Kashyap B. Patel. As CEO of Carolina Blood and Cancer Care Associates in Rock Hill, South Carolina, he recently created a nonprofit group, No One Left Alone, to help cancer patients like Ms. Bell and put them in the spotlight. contact with local charities. The organization covers the cost of her treatments, and Dr. Patel assured her that his office would find the money for her visits.
With a limited budget, “it was very difficult for me,” Ms. Bell said. Inviting her family over for dinner can be a difficult task due to high grocery bills, and she must decide which of her medical needs is most urgent. She postponed receiving a pacemaker.
A new federal report suggests that fewer Americans’ health bills are being sent to collections, but medical debts still account for more than half of all kinds of collections debt, surpassing unpaid credit card or cell phone bills. It remains a serious problem: About a fifth of Californians reported having medical debt of at least $5,000, according to another recent study. investigation. Just over half of those surveyed said they had neglected some type of care in the past year, and half of them said their condition had worsened as a result.
“These are very difficult tradeoffs that people need to think about,” said Dr. Jay Bhatt, executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm. He also sees patients at Family Christian Health Center outside Chicago. In a Deloitte investigation Last year, 28 percent of those surveyed said they were less able to afford care than the year before.
Some patients at the clinic are losing their jobs and insurance, he said. “We’ve seen this before, and we’re going to see it in large numbers now,” Dr. Bhatt said.
In Hammond, Indiana, Tameaka Smith and her husband, Stevenson Lloyd, are facing tighter finances and trying to save where they can. She is disabled and covered by Medicare, the federal insurance program, while her husband, who works in an auto parts factory, has private insurance through his employer.
However, they skimp a little on the medications they need. Her husband takes his thyroid medication every other day, and she sometimes uses her father’s asthma medication. “We self-medicate, try to stretch and self-medicate,” Ms. Smith said.
With two children, their family has not recovered from the financial stresses linked to the pandemic. “It’s hard to catch up when you’re so pushed back,” Ms. Smith said.
Her husband also weighs the benefits of going to the doctor, knowing that if he doesn’t have to pay right away during the visit, “then next month we’ll get a big bill,” she said.
Any economic turbulence has historically led to the loss of medical care for an increasing number of people, either because they no longer have health insurance or because they cannot pay their share of medical bills. During the Great Recession, millions of Americans lost health coverage, and many predict a similar wave in the months to come. Millions of people could lose Medicaid coverage as states begin removing individuals from the program, now that states will no longer have to keep people enrolled and additional federal funds will disappear.
The cost of treatments is also expected to rise next year as hospitals, many of which have reported losses in 2022, will raise their rates, said Sean Duffy, co-founder and chief executive of San Francisco-based Omada Health which provides virtual services. care and coaching for people suffering from chronic illnesses such as diabetes. Company employees were already beginning to see an increase in the number of patients wondering how to pay for medications and healthy eating.
“Unfortunately, it’s 2024 that matters,” Mr. Duffy said.
In addition to medical costs, patients often cannot afford to take time off work to visit the doctor, much less find the funds to cover child care costs or necessary transportation to get there. A colonoscopy to determine why a patient may be bleeding could result in missing a day of work and a medical bill equal to a week’s work, said Dr. Rajeev Jain, a gastroenterologist with Texas Digestive Disease Consultants. “We are seeing an increase in the number of patients canceling for these reasons,” he said.
“You only have so much money to spend on your family,” Dr. Jain said. When we worry about having enough food or stable housing, “at that moment, we’re not thinking about preventing something in five years.”
In 2021, a fifth of Americans delayed or went without medical care because of the pandemic due to a lack of available appointments and fear of infection, according to a study. recent analysis by KFF, a nonprofit research group. Only 5 percent cited cost alone.
Catch-up visits and procedures for people who can now see the doctor and an increase in the number of people seeking care for winter respiratory illnesses could mask a recent decline in the use of medical care.
“It’s possible that this is the calm before the storm, especially since many people are going to lose their Medicaid coverage,” said Cynthia Cox, vice president of KFF.
