NBC News
In 2012, Terry Belk’s beloved wife, Sandra, died after a year-long battle with breast cancer. The Charlotte, North Carolina, car salesman had left his job to care for her, and the bills for her treatment were more than he could afford, even with health insurance. He was also diagnosed with prostate cancer that same year, leading to more expenses for his own treatment.
Atrium Health, the nonprofit hospital that treated the Belks, aggressively pursued them for their debts. Without fully understanding the consequences, Belk said, he agreed to what’s known as a deed of trust under which the hospital will receive about $23,000 when he sells his home — an amount that will cover the outstanding amounts owed for his wife’s treatments. “We weren’t trying to avoid the bills,” he said. “I wanted to pay, but I couldn’t.”
It didn’t end there. In 2022, the hospital sued Belk for the roughly $6,000 he still owed for his prostate cancer care. The man said he knew he couldn’t win in court, so he agreed to pay the debt, which has grown to about $8,000 with interest. Belk said he pays $100 a month to keep it down and keep debt collectors away.
“I’ve been battling this for over 20 years,” Belk, 68, said of her medical debt. “It’s been like an anvil that I drag around every day.”
Americans owe at least $220 billion in medical debt, according to KFF, a nonprofit that provides research, surveys and news on health policy. The three states with the most such debt are South Dakota, where it affects 18% of the population, followed by Mississippi, with 15%, and North Carolina, Belk’s home state, with 13%, according to KFF. The burden of medical debt has contributed to financial anxiety among voters and has become an issue in the 2024 presidential campaign.
Medical debt is a “uniquely American problem,” said Berneta Haynes, a senior attorney at the nonprofit National Consumer Law Center and an expert on the issue. “Even if you have insurance, if you have chronic health conditions that require you to interact more often with the health care system, you’re putting yourself at greater risk for medical debt every time you make” an appointment.
Asked about Belk’s situation, an Atrium Health spokesman said it has used litigation against patients “as a last resort.” Belk signed both the trust deed and the other lawsuit voluntarily, he added, “and presumably on the advice of his attorney.”
An Atrium spokesperson also provided a statement saying, “As the leading nonprofit health system in the Southeast, Atrium Health works to ensure access to high-quality care for everyone in every community we are privileged to serve. For us, there are no profits, only results — in the form of improved health, elevating hope and advancing healing — for all.”
Incorrect invoices and lack of helpNearly 18 percent of U.S. gross domestic product goes to health care, far more than in other developed countries, and about a third of that money is spent on hospital care, according to data from the National Health Expenditures.
With costs so high, it’s no surprise that these expenses are a leading cause of bankruptcy in the country, a 2019 study published in the American Journal of Public Health found. Residents of southeastern states have been hit especially hard by these debts because their state governments have blocked Medicaid expansion.
Nonprofit hospitals are supposed to offer financial assistance programs to patients who can’t afford care, under a provision of the Affordable Care Act. But people aren’t always informed about this option, experts say.
To further complicate the problem, hospital or health care facility bills are difficult to decipher and often incorrect, said Cynthia Fisher, founder of PatientRightsAdvocate.org, a nonprofit that seeks transparency in health care pricing. Fisher’s organization often reviews patient records, and she told NBC News, “We have not yet received an accurate bill.”
A new study from The Commonwealth Fund, an independent research organization focused on health care, confirmed that inaccurate bills are a serious problem. Forty-five percent of American adults say they have received a medical bill that they were surprised was not covered by their insurance, according to the study. Many did not dispute the bills, according to the report, but 38 percent of those who did have the bills reduced or eliminated.
Even when bills are accurate, prices can vary widely for the same service at the same hospital, Fisher’s organization found. In 2023, for example, PatientRightsAdvocate.org studied the costs of five common services, including appendectomies, C-sections and cataract surgeries at hospitals in 10 states.
The research found that an appendectomy at a hospital can cost up to 32 times more than the lowest price for that service at the same location, cataract surgery nine times more and cesarean sections eight times more than the lowest cost. The average for these variations within the same hospital was almost 11 times.
Another problem for patients experiencing overpayments is what happened to Belk, said Sara Sternberg Greene, a professor at Duke Law School and a researcher. “A lot of these people were eligible for relief and didn’t get it,” she said.
“I will probably continue paying in the afterlife”
In mid-August, North Carolina Democratic Gov. Roy Cooper said 99 of the state’s eligible hospitals had signed on to a debt-relief program he championed in which facilities agreed to forgive bills dating back to Jan. 1, 2014, for Medicaid recipients, as well as debts deemed uncollectible for patients whose income is at or below 350 percent of the federal poverty level. Old debts exceeding 5 percent of a person’s annual income also apply. Democratic candidate Kamala Harris praised the program when she held a rally in the state in July.
Unfortunately, according to Belk, the program will not benefit him.
In June, the Consumer Financial Protection Bureau proposed a rule that would remove medical debt from most consumers’ credit records, seeking to address the problem of poor credit associated with these obligations. Under the rule, nearly $50 billion in medical debt would be erased.
Many states aren’t waiting for the federal government to address the debt their residents are saddled with, said Haynes of the National Consumer Law Center. Delaware recently passed a law banning interest and surcharges on medical bills, and Maryland requires hospitals to reimburse patients who were eligible for financial help but didn’t receive it. In 2023, Oregon passed a law requiring people to be screened for assistance if they owe more than $500.
“There is a lot of interest in solving the medical debt crisis,” Haynes said. “Many states are trying to address medical debt and going beyond what the federal government is doing.”
Belk is hopeful that people will benefit from the discussion on the issue. “This is a national problem, people are getting millions and millions of these bills,” he said. “They make people’s lives hell. I’ll probably still be paying in the afterlife.”
