The cost of caring: Medical debt places heavy burden on Kootenai families

When Ariel Morgan began collapsing without explanation, she did what anyone would do: go to the doctor. But without health insurance while between jobs, Morgan could only watch as medical bills piled up while doctors struggled to diagnose her condition.

"I feel like I've put a mountain of debt onto my family," Morgan said. "It's like scooping water out of a never-ending well."

Even now, with insurance covering 80% of her medical costs, her family struggles with about $8,000 in remaining medical debt. This financial strain creates a vicious cycle, as stress exacerbates her health condition, known as Postural Orthostatic Tachycardia Syndrome.

"I wouldn't be so stressed if I wasn't drowning in medical debt," she said.

Morgan's struggle is far from unique in the Gem State. According to Kaiser Health News, about 8% of Idaho adults — approximately 110,000 people — report struggling with medical debt each year. But the impact of medical debt can extend far beyond individual households, affecting crucial life decisions and generations of families.

Vicki Paul needs extra money every month to help pay for her granddaughter's Type 1 diabetes treatment.

"Her insurance literally pays none of it," Paul said.

Together, the family must come up with about $600 a month for insulin and other supplies.

"I have to do pet sitting outside my normal job to earn for all her supplies," Paul said.

The cost of medical care is also keeping Crystal Corbett and her fiance from getting married.

"If we do, I lose my health coverage, and us paying out of pocket for some of my medication I have to take would make us bankrupt in six months or less," Corbett said.

Sometimes the costs can become extreme.

At age 31, Micaela Smith has declared bankruptcy twice due to medical debt from surgeries.

Filing for assistance and fighting with collection agencies adds stress to her recovery from a health crisis, and she believes the cost of her care doesn't make any sense.

For 15 minutes of time spent with a medical professional, she is frequently billed $300-$400.

"The only reason I'm even able to have my surgeries is because I've already met my out-of-pocket deductible," she said. "A couple of years ago, it built up over $300,000 to my insurance in just one year."

Kim Avenger went in for a routine pregnancy scan last summer, and a doctor told her there was something wrong with her daughter's brain.

"The dozens and dozens of medical tests prior to her birth were big tests, all many thousands of dollars," Avenger said. "Before she was even born, we owed much more than we made in a month."

After she was born, Rosalie was hospitalized four times in her first two months of life. She passed away a little while after turning 6 months old.

Throughout her short life, her family battled constantly for her care. When Rosalie needed an emergency brain shunt, for instance, the insurance company wouldn't pay.

"Without it, she would've died at f5 weeks old. The insurance company determined it was not a necessary surgery," Avenger said.

The family now uses the food pantry in Post Falls and has applied for financial assistance. They keep Rosalie's legacy alive while trying to make ends meet.

"We do not want to ask for more money from those who have loved and given us so much of themselves already," Avenger said.

Part of the problem is the skyrocketing cost of health care. The cost of medical care typically outpaces inflation, and it's on pace to do so again in 2024, according to Peterson-KFF, a group that tracks the health care system.

Jennifer Fletcher, a nurse practitioner at Active Family Healthcare, is worried about the future of health care access.

"Our expenses are radically more expensive, but insurance hasn't adjusted reimbursement," Fletcher said, pointing to a growing disconnect between the cost of providing care and the reimbursement rates from insurance companies.

Her concerns were echoed by Kootenai Health CEO Jamie Smith, who at a recent Rotary Club meeting, spoke about the increased cost of care.

"It's a difficult challenge at times," Smith said of insurance companies. "Our interests are not quite aligned, are they? They want to pay us as little as they can, and we want to get the most we can."

Peter Sorensen, a vice president for Blue Cross of Idaho, said things have changed for insurance companies because more claims are being filed. He attributed this to an aging population and an increase in the number of people with chronic conditions like obesity. He also said the cost of prescription drugs continued to increase and that people are overutilizing emergency rooms.

He also pointed to government policy changes — both from Congress and the White House — that have driven up the cost of Medicare. That means fewer people can find care under the program.

Although 98% of seniors in Idaho qualify for Medicare Advantage coverage, for instance, some insurance carriers simply won't offer them a policy.

"We are seeing a trend by many insurance carriers to exit all rural Idaho counties and only offer MA coverage in urban areas such as Boise and Coeur d'Alene. Once again, rural Idaho seniors will likely have fewer Medicare coverage options due to federal regulations that simply don't calculate for the costs and challenges with serving rural counties," Sorensen said.

For now, there doesn't seem to be much of a solution, but there are a few resources.

The Department of Insurance can help with billing complaints and insurance claims. They also have an external review in which where the patient and the insurer can make their case in front of an appointed officer for services and drugs that were denied.

The Idaho High Risk Reinsurance Pool provides coverage for some of the most expensive conditions and is funded with premium taxes paid by insurers and with federal funds.

The DOI also investigates insurance fraud and the inappropriate denial of claims.

Consumers can contact the DOI at 208-334-4319 or [email protected].