5 jobs not enough to pay med­i­cal bills

Mid­dle class fam­i­lies find in­sur­ance isn’t covering their costs

The Dallas Morning News - - Business - By JONEL ALECCIA Kaiser Health News

Robert and Tif­fany Cano of San Tan Val­ley, Ariz., have a new mar­riage, a new house and a 10­month­old son, Brody, who is de­lighted by his abil­ity to blow rasp­ber­ries.

They also have a stack of med­i­cal bills that threat­ens to un­der­mine it all.

In the months since their sturdy, brown­eyed boy was born, the Canos have ac­quired more than $12,000 in med­i­cal debt — so much that they need a spread­sheet to track what they owe to hos­pi­tals and doc­tors.

“I’m on these pay­ment ar­range­ments that are killing us,” said Tif­fany Cano, 37, who has spent her lunch hours on the phone ne­go­ti­at­ing pay­off plans that now to­tal $700 a month. “My hus­band is work­ing four jobs. I work full time. We’re a hard­work­ing fam­ily do­ing our best and not get­ting any­where.”

The pair, who earn nearly $100,000 a year, are in­sured and have had no ma­jor ill­nesses or in­juries. Still, the Canos are among the 1 in 4 Amer­i­cans who re­port in mul­ti­ple polls that the high cost of health care is the big­gest con­cern fac­ing their fam­i­lies. And they’re at risk of join­ing the 62 per­cent of peo­ple who file for bank­ruptcy tied to med­i­cal bills.

“Oh, yes, that worry is al­ways in the back of my mind,” Tif­fany said.

The fam­ily is part of a strug­gling group: mid­dle­class folks who have fol­lowed the rules and paid for em­ployer­based med­i­cal in­sur­ance, only to find that soar­ing health care costs — com­bined with high de­ductibles, high co­pay­ments and sur­prise med­i­cal bills — leave them vul­ner­a­ble.

“I thought we’d be cov­ered, and it’s just not enough cov­er­age at all,” she said.

‘$300 here, $700 there’

Robert Cano, also 37, had fam­ily health in­sur­ance for 2018 through his job as a man­ager at a large­chain re­tail store, for which he pays nearly $500 a month. The plan’s $3,000 an­nual de­ductible and 40 per­cent coin­sur­ance fees have added up faster than the Canos an­tic­i­pated.

First came the nearly $4,000 bill from the in­net­work hospi­tal where Brody was born Jan. 2, fol­lowed by sep­a­rate fees from the anes­the­si­ol­o­gist and the doc­tor who per­formed the rou­tine delivery. Then, at 2 months, Brody was hos­pi­tal­ized with breath­ing prob­lems doc­tors said could be re­lated to al­ler­gies or asthma. In May, Tif­fany came down with a stom­ach virus that sent her to the emer­gency room for drugs to treat nau­sea and de­hy­dra­tion. In Oc­to­ber, the baby de­vel­oped a bad case of bac­te­rial con­junc­tivi­tis, or pink­eye.

“It’s been, like, $300 here, $700 there,” said Tif­fany. “We had a hospi­tal bill for him be­ing sick of, like, $1,800.”

Un­able ini­tially to find a pe­di­a­tri­cian she liked, Tif­fany has ag­o­nized over whether to use the ER when Brody gets sick. When he had pink­eye, she de­bated whether to take him in, hop­ing it would get bet­ter on its own.

Then he got worse, she said, pulling up a photo on her phone of her son with half­moons of red, puffy flesh un­der his dark eyes. “I let him suf­fer for a day like that,” she said.

The Canos lost their first child, a girl, mid­way through her preg­nancy in 2016. Tif­fany ac­knowl­edges that ex­pe­ri­ence has left her more anx­ious than the av­er­age first­time mom. “It gave me so much fear that some­thing would hap­pen to him,” she said.

As for their own health care needs, the cou­ple put them­selves lower on the pri­or­ity list. Tif­fany has used a pros­thetic limb since child­hood, when her lower left leg was am­pu­tated be­cause of a birth de­fect. She needs a new pros­the­sis be­cause her body changed dur­ing preg­nancy, but she can’t see how to af­ford it.

A model suitable for the busy life of a work­ing mom would eas­ily cost $10,000 to $15,000, ac­cord­ing to Tom Fise, ex­ec­u­tive di­rec­tor of the Amer­i­can Or­thotic & Pros­thetic As­so­ci­a­tion.

“I try to push through,” Tif­fany said. “I put on that brave face of just walk­ing, but it’s so painful to walk. I have bruises all over my leg. I get blis­ters all the time.” Lately, she’s been wear­ing an old pros­the­sis, one she used in high school, be­cause it’s more com­fort­able.

Fam­ily over Army

The Canos don’t know how ex­actly they fell into such debt, since they tried hard to make re­spon­si­ble de­ci­sions. After meet­ing three years ago, they knew quickly that they wanted to marry and have a fam­ily.

“I waited un­til I found the right guy,” said Tif­fany, who was thrilled when, in 2016, they were able to af­ford a 2,500­square­foot, two­story home in one of the stucco­and­tile neigh­bor­hoods an hour out­side Phoenix.

But, taken to­gether, the med­i­cal pay­ment plans and pre­mi­ums are al­most as much as their $1,300 monthly mort­gage. All told, the Canos spend about 15 per­cent of their an­nual in­come on health care, al­most three times the av­er­age for non­medi­care house­holds in the U.S.

That leaves too lit­tle for day care, car pay­ments, gas, food and dozens of other do­mes­tic ex­penses, Tif­fany said.

For 17 years, Robert Cano had com­pre­hen­sive health in­sur­ance through his job as a soldier in the Army Re­serve and paid lit­tle or noth­ing for med­i­cal care. He left the Army in 2017, how­ever, after he learned he would be de­ployed for an ex­tended time away from his wife and new son.

“I told them, ‘I have to be at home,’ ” he re­called. The Army in­sur­ance ended Dec. 31, 2017, two days be­fore Brody was born.

That meant mov­ing to his em­ployer’s in­sur­ance plan. Like more than 40 per­cent of 152 mil­lion Amer­i­cans who get health in­sur­ance through work, the Canos are en­rolled in a plan that de­mands thou­sands of dol­lars be­fore any cov­er­age kicks in.

The cou­ple dis­cov­ered that they earn too much to qual­ify for fi­nan­cial as­sis­tance from med­i­cal providers, or for sub­si­dies if they shifted their in­sur­ance to a plan un­der the fed­eral health in­sur­ance ex­change. She is a full­time bank com­pli­ance of­fi­cer. He is a full­time store man­ager.

Tif­fany wrote to Kaiser Health News after see­ing sto­ries about sky­high med­i­cal bills on TV. Dr. Mer­rit Quarum, chief ex­ec­u­tive of Wel­lRithms, a health care con­sult­ing firm, re­viewed the fam­ily’s med­i­cal bills and the re­sponses from their health care providers.

Though Quarum had ques­tions about some of the fees in the item­ized bills — $4 for a 600mil­ligram ibupro­fen tablet? $3,125 to place an epidu­ral? — he found the charges were le­git­i­mate un­der the terms of the con­tract be­tween the hospi­tal and the Canos’ in­surer. Tif­fany’s only re­course was to set up the five pay­ment plans she nav­i­gates each month.

“I wish I could say it wasn’t so, but it is,” Quarum said.

‘I will not give up’

Mostly to pay off that health care debt, Robert has taken sev­eral part­time gigs re­cently — he works as a sub­sti­tute teacher and a night­time se­cu­rity guard and de­liv­ers sand­wiches for a fast­food chain in Scotts­dale, 40 miles away, where tips are bet­ter. He said he some­times works up to 120 hours in a week.

“I’m not ashamed or em­bar­rassed, even as old as I am, to de­liver sand­wiches,” he said, pulling on his re­tail chain polo shirt be­fore rush­ing to a Satur­day morn­ing shift.

He con­tin­ued: “I know peo­ple, they’d rather get food stamps and feel sorry for them­selves. But I’m a fighter. I will not give up . ... If I can bring in an ex­tra $400 a week or $800 a month, she can get what she needs for the baby.”

Of­ten get­ting home after mid­night, he keeps sham­poo and shav­ing cream in his car and naps in park­ing lots be­tween jobs, re­ly­ing on Red Bull and as­pirin to stay alert.

That means on many nights, when Tif­fany picks up Brody from day care after her 90­minute com­mute, she han­dles most of the chores at home. “Some­times I feel like a sin­gle mom be­cause my hus­band is never around,” she said.

She care­fully tracks the fam­ily’s med­i­cal ex­penses, try­ing to jug­gle them with or­di­nary out­lays that can’t wait — like $500 for the brakes that went out on her car this month.

At the rate they’re go­ing, the bills won’t be paid un­til Brody is 3, Tif­fany said. The Canos are get­ting older and they’d like to have an­other baby be­fore it’s too late, but, for now, that seems im­pos­si­ble.

A new health plan

For 2019, the cou­ple have de­cided to switch to a dif­fer­ent plan of­fered through the re­gional bank where Tif­fany works. The premium is higher — $650 a month — but the de­ductible is $1,500 with just 10 per­cent coin­sur­ance.

“It is go­ing to be a lot more per pay­check, which is go­ing to hurt us,” Tif­fany said. “But after what just hap­pened, I want to make sure we are pre­pared in case any­thing does oc­cur.”

How to fix a health care sys­tem that bur­dens mid­dle­class fam­i­lies so heav­ily is be­yond her, she said.

“The only thing we can do is just keep work­ing,” Tif­fany said. “I al­ways won­der: How does ev­ery­body else do it?”

Jonel Aleccia is a se­nior cor­re­spon­dent at Kaiser Health News. She can be con­tacted by email at jalec­[email protected] and fol­lowed on Twit­ter @Jonel_alec­cia. KHN’S cov­er­age of chil­dren’s health care is­sues is sup­ported in part by the Heis­ing­si­mons Foun­da­tion.

Heidi de Marco/ Kaiser Health News

Robert and Tif­fany Cano have racked up nearly $12,000 in med­i­cal debt since Brody was born, even though the fam­ily has in­sur­ance and has had no ma­jor ill­nesses or in­juries.

Heidi de Marco/ Kaiser Health News

Robert Cano of San Tan Val­ley, Ariz., es­ti­mates he works up to 120 hours a week, mostly to cover the ex­tra costs of his fam­ily’s health care. In ad­di­tion to his re­tail job, he is a sub­sti­tute teacher, a night­time se­cu­rity guard and a sand­wich de­liv­ery­man.

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