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Americans are no strangers to medical debt, and the burden is most severe in Mississippi, where nearly 40 percent of adults under age 65 owe hospitals or doctors, according to the Urban Institute. But the men and women carrying that debt are not always poor — they’re increasingly middle class.

And their inability, or refusal, to pay their bills is straining hospital budgets and threatening the availability of care.

“You’d be surprised when you look through our bad debt rolls,” said Alvin Hoover, CEO of King’s Daughters Medical Center in Brookhaven, Miss. “Some drive a 2002 pickup truck, and some drive a 2016 pickup truck. Those are the ones that get under your skin — where you went to buy a 2016 truck when you still owe the hospital $4,000.”


Mississippi, where the median household income hovers near $40,000, has one of nation’s highest rates of uninsured and underinsured adults. As a result, the state has one of the highest percentage of adults who avoid doctors due to potential costs, said Therese Hanna, executive director at the Center for Mississippi Health Policy.

At the same time, medical debt remains the leading cause of bankruptcies, according to Roy Mitchell, executive director of the Mississippi Health Advocacy Program.


Thomas Ash, a bankruptcy lawyer based in Jackson, said more than half his clients carry medical debt. He often sees this kind of debt accumulate because residents have purchased catastrophic insurance plans but have failed to set aside savings to cover high deductibles or expenses not covered by the policy.

“If they couldn’t pay the deductible,” said Mississippi Hospital Association CEO and President Tim Moore, “there’s a high probability they’re not going to pay the hospital.”


Medical debt graph 1
The Urban Institute

Collection agencies are most likely to go after past-due medical bills first, according to a recent study from the Consumer Financial Protection Bureau. Over the past five years, James Henley Jr., a bankruptcy trustee in Jackson, said he has seen a sharp increase in the number of middle-class residents with bankruptcy claims after “extending their lines of credit, maxing out credit cards, [robbing] Peter to pay Paul.”

Henley said the people he works with have to make hard choices, and that new car may not signify that they’re thumbing their nose at their debt.

“You have medical debt, a mortgage, and utilities — and those costs are rising,” Henley said. “Your 2005 pickup truck is getting old. Your maintenance costs are going up. You can pay those, or you can buy a new car to ensure you show up to work.”



It wasn’t that long ago that Cheryl Trosclair and her husband brought home a combined annual income of over $100,000. Then a few years ago, Trosclair found herself unable to work in the wake of fibromyalgia, kidney disease, and clogged arteries. After that, her husband was laid off from his supervising job on an offshore oil rig. They lost medical coverage. Dealing with chronic health issues, she racked up thousands of dollars in medical debt.

They eventually moved to tiny Silver Creek, Miss., where her husband’s family lives, to figure out their next step. They’re living off proceeds from property they once owned in Louisiana. Meanwhile, Trosclair is awaiting word about her disability claim. For now, she has a high-deductible plan purchased through the state’s insurance exchange. In short, times have stayed tough.

“I just go to the doctor in cases of an emergency,” Trosclair said. “I don’t like to owe anybody.”

A few months ago, Trosclair’s right knee gave out, and she fell, face-first, into a fire at her friend’s house. She spent four hours trying to avoid a hospital visit. When the pain from burns to her face grew intolerable, she went to King’s Daughters’s emergency department.

Trosclair said she received excellent care. But it cost $1,500.

After much uncertainty, King’s Daughters wrote off the bill as charity care. Since then, Trosclair has experienced pain from her rheumatoid arthritis and a separate episode of chest pains. Her husband asked if she wanted to go to the doctor. But she worries about increasing her medical debt beyond the thousands of dollars she still owes from back in Louisiana.

“Let’s just wait,” she told her husband.



Hoover has plenty of patients like Trosclair at King’s Daughters. He also has people who haven’t paid five-figure bills despite making more than $70,000 a year. Ultimately, he knows hospitals suffer when millions of dollars in bills go unpaid —  no matter if that’s the result of bad luck or bad financial decisions.

Delta Regional Medical Center, a 325-bed hospital in Greenville, struggled to stay in the black in 2016. CEO Scott Christensen said the hospital was left in a tenuous position when it posted only a net profit of $1.5 million even though it collected $125 million last year. The tight margin, he said, was largely due to $31 million that went uncollected. Half of that amount is from bills that middle-class patients have yet to pay.

“I don’t want to judge their life choices, but in an age of expediency, there’s no savings for a serious health care bill a year from now,” said Christensen.

Christensen said he considers hospitals to be the bedrock of Mississippi’s communities. So when people don’t pay, he said, entire communities suffer. Henley pointed to recent layoffs at the University of Mississippi Medical Center, a hospital that has struggled to collect bad debt, as one such example. A UMMC spokesperson declined to make hospital officials available for this story.

Over the past five years, Hoover has instructed King’s Daughters staffers to collect payments up front from patients who come in for non-emergency treatment. They have also tried to divert patients away from the emergency room unless they absolutely need critical care. And they’ve tried to negotiate payment plans with patients for a fraction of their outstanding debt.

The strategy has worked to a degree  the hospital cut its bad debt nearly in half, from $22.5 million in fiscal year 2012 to $12.6 million in fiscal year 2016, adding close to $10 million to its profit margin.

Elsewhere in Mississippi, there are plenty of opinions from experts and advocates on how to reduce past-due medical debt: expand Medicaid, create jobs, let providers become insurers. But right now, with no clear solution, hospitals are likely to remain mired in debt, just like their patients.

“We’re just trying to survive,” Christensen said.

  • What an utterly ridiculous story. Alleged “data,” produced by Democrats, promotes the Democrat position.

    Absurd and fake, on its face.

    FACT: smoking, dope, heavy boozing, over-eating, and “wild living” cost 2+ PPACAs.

    Why don’t Schumer and Pelosi lecture their pals about that? What are they afraid of?

    • @bing, Where are your facts? I can tell you being in healthcare people are losing their homes and savings because capitalism that doesn’t deliver quality healthcare.
      The third leading cause of death, according to the CDC, is hospital errors or mistakes.

      Thanks for your political attack as that doesn’t bring or contribute the answers needed for many that can’t afford healthcare.

    • B: why, of course .. smoking doesn’t kill, and the government civil service is filled with Republicans. And pigs fly.

      Democrats make their money, creating a constant storm of alleged “problems.” They never mention (1) higher taxes in OCED countries, (2) long waiting lines (baby Charlie), and (3) that those countries are nothing like the USA. Example: Australia immediately jails any suspected illegal immigrant. And Japan is 99% Japanese — no diversity.

      Facts are facts. Deal with them, or remain a child. Your choice.

    • I’m cracking up laughing. You really need to get out more.

      I will spare the statistics on second hand smoke and smoking regardless of location, type, length of exposure, or the warning label and why.

      In addition to Australia and Japan that I have visited not as a tourist, I will allow you to form your own opinion.

      Stay cool and enjoy the day.

  • This only happens in the US. In other foreign countries with universal coverage people don’t have to worry about paying a big bill if they get sick. People will argue that taxes to pay for this are very high. That may be true, but racking up huge bills ends up being far more expensive. My wife recently had to be hospitalized for osteomyelitis. We have what I thought was very good insurance coverage. Medicare and a supplemental policy to pay for what medicare didn’t pay. Medicare pays for 100 days and the same is true for the supplemental. After 100 days we were on our own. I ended up paying over $70,000 out of pocket. This in a short time whiped out years of saving. One may think they have all bases covered but in our system it’s an impossible task. Unless of course you are very wealthy. If we lived in a country with universal coverage this wouldn’t happen or the threat of bankruptcy and losing everything wouldn’t be a worry. With an aging population and more expensive treatments my story will become more common. In fact most people in a skilled nursing home , lose all of their assets and depend on medicaid to pay for their care. You get to keep $50 per month of your income and the rest goes for your care. If you are young this is an example of what your world will be like if you get old.

    • @JackieBass, Yes, you nailed it! The USA pays more in healthcare than any other country and doesn’t provide quality at that cost, depending on location.
      I’ve created friends in Sweden and healthcare is provided with exception of delay in non emergent surgery because of staffing. If you are elderly or need assisted living, out of pocket cost only 75 US dollars. 7 different healthcare professionals check on you or your family member daily.
      Yes, taxes are a little high in Sweden but having peace of mind with needing healthcare I could live with it. Plus you don’t lose your home or savings over a catastrophic healthcare event!
      We are to be living in the greatest country in the world yet the level of strife in US Congress will not be solved in 20 years.
      Hang in there!

  • I live in Mississippi. I lost my job over cancer (actually 2 of them in one year which were cancers #2 and 3). Despite finding other work (all part time, no insurance offered, still can’t get full time employment), I still had food stamps. MS did not expand medicaid. I finally had to choose between rent and insurance. I ended up homeless for 19 mo. I am now in HUD housing, still looking for full time work. ALL my income goes to health insurance because I make too little for a subsidy and a gofundme has bailed me a couple of times. I also owe U of MS around $1000 (although I qualify income wise for their poverty program they won’t help me with their poverty program because I have insurance. Ironic since my insurance has paid more than they would have required me to pay had I been allowed to use their poverty program). I owe MD Anderson Cancer center around $7000 or so. I am making payments on that, although at the moment I am a month behind. Fail to make payments and they won’t see you. The U of MS Med Center bill isn’t old enough to know what they will do to me if I can’t pay much (new diagnosis – progressive demyelinating peripheral neuropathy).

    Our governor doesn’t care what happens to us – based on comments he has made I can only conclude he is hoping to solve the state’s poverty problem by denying the poor health care. Declaring bankruptcy doesn’t help if you have chronic health problems – you will continue to rack up bills you can’t pay and will have to wait 7 years to declare bankruptcy again. Those who qualify for subsidies should be in better shape since their out of pocket is limited. Those right about the cut off are likely in trouble too.

    And of course with the current attempts in DC to change health insurance, and not for the better for those who actually have to use it, this situation will get worse, rather than better. Personally I think some of those folks have had an empathy lobotomy. I have paid for health insurance for decades and rarely ever had expenses that even used up very reasonable deductibles. Now that I have health problems I guess I am no longer a profit center so throw me, and others, to the wolves? Sheesh. Only in America.

    • Your story or life journey of decades of hell in something you didn’t ask for is the EXAMPLE that healthcare or insurance company or college loan should provide the NEEDED healthcare and write off any debt unless you or others have some type other type of income.
      This should not be a political issue as it’s made out to be with healthcare.
      We live in the so called “greatest nation in the world” and when we the people can not take care of our veterans, mental illness, or chronic health issues, then we fall short because other nations are spending much less and delivering better healthcare.
      If I were you, I would learn another language for another country that can manage your healthcare and not look back when you move!
      We can billions for war, drugs, and over crowding foster care, prisons, yet we can not take care of good people like yourself.
      I hope your circumstances improve soon.

    • First, Anon, sympathies on your situation. At least three female friends have died of cancer, I understand the issue.

      About Medicaid expansion: this is brutal, but in frank honesty, moving to Louisiana or Arkansas (next door) would be a good option. They approved Medicaid expansion.

      As to the outstanding bills, if it were me, I would write the hospitals again, cite all the confusion .. and ask that your bills, be cited as “charity case,” either partially or in full. Most hospitals are required to grant charity status to a certain % of cases.

      The USA is the best country is the world, where kings and queens come for medical treatment.

      It also does not need Ivory Tower gas-bags to tell those in the trenches, what to do — we know what has to be done. Assess penalties for unhealthy behavior (smoking, dope), drive out waste and fraud, and let patients help decide what needs to be done. That would be a start.

  • This is like the 1990s all over again. Low wages. No jobs because they moved to another state, country, or closed. We, humans, can’t be defined by our purchases as we have to be happy and slaved to out of control healthcare costs, utilities, mortgages, etc. or we become ill.
    At the end of this great contrast of an article, expand Medicaid or a program that is affordable.
    This is what Pres. Obama requested from all the health insurance association, hospital association, American Heart, and 30 other healthcare governing bodies to create a healthcare coverage so hospitals, clinics, become paid at affordable cost.
    We are the only nation on Earth that creates capitalism out of a human biological need with healthcare demands. There are so many great examples from other countries that are making it happen through flat tax.
    I digress. Time for people involved on all sides to meet in the middle so every social class wins.

    • ” .. Those are the ones that get under your skin — where you went to buy a 2016 truck when you still owe the hospital $4,000.”

      That is NOT bankruptcy, Ms. Warren (D). Those are deliberate, poor choices.

      That is NOT my problem. That is THEIR problem. Stop forcing others to fix the problems of fools and drunkards.

    • What gets me is that 4000.00 owed was probably for a CT scan that costs 300 during business hours and 2 separate doctors fees when the ER doctor consults with his supervisor. That’s about what is costs for an ER visit here for one kidney stone and no treatment. What a waste of money. You are basically paying for everyone else. If I had seen the menu of services and the prices I would have walked out and waited. They even insulted me by asking if I took pain meds regularly.

  • “Dog bites man” story. Now if this journalist wrote a story digging deep about the fundamental reason that health care so expensive….well, that would be interesting. And astounding.

  • Clue for writer, paragraph #3: It is often today more economical to lease a new vehicle than buy a used one or repair an elderly one. Many working people in rural areas need a reliable truck to make a living. Understand quoted’s frustration at perception, but not reality. Poor bashing to feature in top of article.

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