Medical debt can keep people homeless longer

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According to a study in King County, Washington, medical debt prolonged the period of homelessness for people by two years on average.

Medical bills were the main source of debt for those participating in the study.

Research Shows Medical Debt Takes Millions Of Americans: Depending on how you define “medical debt,” studies by nonprofits and academic institutions typically show that 16% to 28% of adults carry this burden.

And medical debt and housing instability often go hand in hand.

“So many people have lost their jobs, then they lose their health insurance. They may not be able to pay even small medical bills or co-pay and to rent Where mortgage payments. If they get sick with it coronavirus, or some other medical condition, it may be the perfect storm that puts people on the streets and increases the time they spend there, ”says Jessica Bielenberg, who conducted the study for her master’s thesis at the School of Public Health of the University of Washington. .

The study appears in Survey: The Journal of Health Care Organization, Delivery and Funding.

Little research has been done to establish a link between medical debt and homeless, says Bielenberg. Although her study did not find a direct causal relationship between the two, she determined that among the homeless, the inability to pay medical bills, even a few hundred dollars, was associated with significantly more time spent. without accommodation.

In about a third of the cases, the amount of medical debt was relatively small – less than $ 300.

Bielenberg and his coauthors worked with two Seattle organizations supporting shelters and settlements for the homeless: SHARE and Nickelsville. The team interviewed 60 adult residents about their health and financial situation, including other debts and past periods of homelessness. Two-thirds of the participants were white, 15% were black, and 7% were Native American.

Participants whose medical bills were sent to collections experienced homelessness for an average of 22 months longer than those who had not had as much difficulty paying their bills; Blacks, Aboriginals, and people of color who were unable to pay their medical bills reported being homeless a year older than white participants facing the same financial challenge.

“If black lives really mattered, we wouldn’t systematically exclude these people from good jobs – and a good job in America is a job with health insurance,” says co-author Marvin Futrell, clinical instructor in the Department of Health Services from the University of Washington. and an organizer with SHARE and Nickelsville.

In total, more than 80% of participants reported having debt of some kind, such as doctor bills, student loans, credit cards or payday loans. Of these participants, 68% reported medical debt, the majority of which had been recovered.

In about a third of the cases, the amount of medical debt was relatively small – less than $ 300. This highlights what for many people can be a domino effect, according to Bielenberg: A job loss or lack of health insurance can overwhelm a person with debts that they should prioritize, if they can pay them.

Medical debt, health insurance and homelessness

Medical debt is a different type of debt than, for example, overdue credit card bills or student loan payments, which can protect against short-term homelessness, Bielenberg explains. A person who makes student loan repayments has an education, which can improve their earning capacity, while credit cards and payday loans can cover basic needs, even if they come with interest rates. high interest. Medical debt, by its nature, arises from illness or injury and may accompany loss of employment or lack of health coverage.

But what might be seen as a safety net – health insurance – hasn’t always been that, Bielenberg found. Two-thirds of the participants were enrolled in Washington’s Medicaid program, Apple Health, while others had coverage from Medicare, the Indian Health Service, or the Veterans Health Administration. Some 16% said they had no insurance coverage.

Insurance doesn’t always cover everything, Bielenberg says, and even those who are comfortably insured can lose track of the costs they incur.

Is it time to change the system?

The study did not examine or advocate specific solutions, but Bielenberg suggested that additional research, with larger and more diverse participant pools, could strengthen the case for policy change or new programs. Support.

“Fortunately and unfortunately,” says Bielenberg, “we are in a time of considerable turmoil. Sometimes these times are the perfect time to completely rethink the way we do things. The United States could join the vast majority of countries in the world and simply offer universal health coverage. We spend twice a person on medical care than any other country, so we are obviously doing something wrong. “

Bielenberg received a scholarship from the Northwest Center for Public Health Practice to support his graduate studies.

Source: Washington University

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