Oklahoma among worst states for medical debt

All things considered, she was just grateful to still have transportation.

But as a place to sleep, Leticia De Alegria’s car left a lot to be desired.

“I’ve spent the night there a couple of times,” said the Tulsan, who more than once in the past few years has faced the possibility of becoming homeless.

“I couldn’t go to sleep in my car, though. I was afraid someone would break in. I did not know. It was heartbreaking for me to be in this situation. »

Luckily, De Alegria has since moved in with a family member.

But his overall financial situation has not changed.

“I just don’t know what’s going to happen,” she said, adding that it looks like the hard times are here to stay.

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De Alegria, whose downward spiral began with a work injury, is one of countless Oklahomans who have felt the burden of medical debt.

The state ranks among the worst in the nation for unpaid medical bills, which are especially hard on the most vulnerable populations.

According to a recent report by the Urban Institute, nearly 22% of Oklahoma residents have medical debt in collection. That’s the third-highest rate nationally, behind South Carolina and West Virginia. In Oklahoma’s communities of color, the number jumps to 32 percent.

As for the two most populous counties in the state, in Tulsa County, 19% of residents overall (32% of communities of color) have medical debt in collection; in Oklahoma County, it’s 22% (35% communities of color).

Harmon and Greer counties in southwestern Oklahoma — with 42% and 39% of residents, respectively — top the state and rank among the top 10 nationally among counties for which numbers are available.

No one is more aware of the problem than the organizations that serve the state’s most vulnerable residents.

“At least once a day now I see someone who has a medical debt problem. It seems to be becoming a bigger issue,” said Veronica Robles, case manager at the Catholic Charities Emergency Assistance Program in Tulsa.

“So often it comes on top of everything they’re already dealing with.”

Medical debt is also a common concern for client families of Green Country Habitat for Humanity, said Cameron Walker, president and CEO.

“Where we see its impact is not so much in the beginning, but after they own a home and pay a mortgage,” said Walker, whose nonprofit helps low-income families to build their own homes.

Often, medical bills are part of a “bundle of debts” customers face, along with student loans, high-interest auto loans, and more, he said.

“Our families are on such tight financial budgets that they are often one major life event away from being completely knocked over.”

When this event occurs, it is often medical.

“It’s not the fault of the owners themselves,” he added. “This is not a misallocation of funds. It’s just a lack of excess funding.

Oklahomans have not been idle about the issue.

A recent Tulsa-based partnership with RIP Medical Debt, a national nonprofit organization, raised funds to help over 36,000 Oklahomans erase nearly $41 million in medical debt.

But how to prevent families from accumulating this debt remains a problem with no obvious solution.

Leaders hope the Medicaid expansion — which Oklahoma has embraced, unlike some other high-ranking states — will help.

Since it took effect in July 2021, more than 300,000 Oklahomans have been covered.

It is still too early for the medical debt figures to reflect any impact. But promisingly, the percentage of Oklahomans without insurance is down from 14.4% to 9.6% since the Medicaid expansion, according to the Oklahoma Policy Institute.

“Financial Sorting”

De Alegria, who moved to Tulsa from Tucson in 2019, has always been proud to work and support herself.

But almost overnight, her life in her new town was turned upside down.

She was injured on the job, and it led to three separate surgeries.

Today, although generally recovered, she has physical limitations that have prevented her from finding work.

Worse still, De Alegria had no health insurance at the time.

And so far, though still pending, efforts to secure workers’ compensation and disability benefits have been frustrating.

The end result, she said, is a financial nightmare that includes thousands of dollars in medical debt.

Peter Chacon, emergency relief manager for Catholic Charities of Eastern Oklahoma, said the organization is trying to intervene before medical debt becomes a problem, by helping households get insurance.

“The biggest problem behind unpaid medical bills is unpaid bills, period,” he said. “Customers must choose between paying current bills for basic needs and insurance coverage for potential future medical bills. And they choose to meet their most pressing needs first.

Clients without insurance are more likely to avoid preventive care, which in turn leads to much larger bills when care is eventually sought, he said.

The average cost of a three-day hospital stay is about $30,000 — “more than the total annual income of someone at or below the poverty line,” Chacon said.

“So for poor households, it’s a matter of financial sorting. A massive expense that there is no realistic way to repay becomes the lowest priority for households in financial difficulty. Would you like to pay your $400 savings for a $30,000 medical bill and not have a dent or buy a new set of tires to get to work? Or pay your utility bills? »

“Everything is just snowballs”

The issue of medical debt wasn’t the only reason, but it was certainly a factor in Green Country Habitat becoming a HUD-approved homeowner counseling agency, Walker said.

“We wanted additional tools available to us to help customers pay off their debt,” said Walker, whose organization has built 100 homes in the past 22 months, most serving people of color in North Tulsa. .

Walker said more than 50% of the organization’s client households have a single head, in most cases a single mother.

A recent situation for one of them, he said, has become all too common.

“We have a household with a single mother who has a child with a serious illness. She had to take time off from work and, with out-of-pocket medical bills, she fell behind on mortgage payments.

Habitat has been able to intervene on behalf of clients in many mortgage cases, Walker said.

“We can kind of step in and be that middleman between the bank and the family, and we can usually work with them, either modifying or buying time,” he said.

“But I can tell you from experience that a lot of families are panicking. They face all these things, maybe a child in the hospital. They are afraid. So they don’t contact us, and everything snowballs.

Medical debt is often an additional factor and stressor. And the situation for customers is not improving with the current inflation.

“We’re facing rising fuel costs, rising groceries, rising energy costs,” Walker said.

“It’s a real issue, and we’re really scrambling right now to talk with funders and people in the philanthropic community.”

While her future remains uncertain, De Alegria is grateful for the philanthropic spirit she encountered in Tulsa.

It starts with Robles and Catholic Charities, which have continued to be there for her, providing food and various services.

“They did so much for me,” she says.

Without the help of the charity and the family members who took her in, she is afraid to think about what could have happened.

“I’d probably be under a bridge,” she said.

“It’s so hard to think how any of this could happen to me.”

ICYMI Video: October 2022 Flashback from Tulsa World

Photojournalism by Tom Gilbert, Ian Maule, Stephen Pingry, Mike Simons and Daniel Shular from October 2022.

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John A. Bogar