A father dreamed of a house for his household. Medical debt almost pushed them onto the streets.

Kayce Atencio was haunted by a thought whereas working at a homeless shelter in downtown Denver. «It might have been me,» mentioned Atencio, 30, who lives in a small condo along with his son and daughter not removed from the shelter.

It almost was. Atencio and his youngsters for years slept on associates’ couches or stayed with household, unable to lease an condo due to poor credit score. A giant purpose, he mentioned, was medical debt.

Atencio had a coronary heart assault at 19, triggered by an undiagnosed congenital situation. The money owed from his care devastated his credit score rating. «It all the time felt like I simply could not get a leg up,» he mentioned, recalling a lifetime of dead-end jobs and high-interest loans as he tried to remain forward of debt collectors. By 25, he’d declared chapter.

Throughout the nation, medical debt forces legions of People to make painful sacrifices. Many in the reduction of on meals, tackle additional work, or drain retirement financial savings. For tens of millions like Atencio, the well being care system is threatening their very properties.

That is confirmed significantly devastating in communities like Denver, the place skyrocketing costs have put housing out of attain for a lot of residents and fueled a disaster that is left hundreds homeless and sleeping on the streets.

On the Group Financial Protection Challenge, or CEDP, a Denver nonprofit that helps individuals dealing with eviction or house foreclosures, about two-thirds of shoppers have medical debt, an off-the-cuff survey by KFF Well being Information and the group suggests. Near half of the almost 70 individuals surveyed mentioned medical debt performed a job of their housing challenge, with about 1 in 6 saying it was a significant component.

«All day lengthy I hear about medical debt,» mentioned Kaylee Mazza, a tenant advocate who staffs a CEDP authorized clinic on the Denver courthouse that provides support to tenants going via eviction proceedings. «It is in every single place.»

Nationwide, about 100 million individuals have some type of well being care debt. Of these, about 1 in 5 mentioned the money owed have pressured them to alter their residing state of affairs, together with shifting in with associates or household, based on a 2022 KFF ballot.

A rising physique of proof exhibits that secure housing is essential to bodily and psychological well-being. Some main medical techniques — together with a number of in Colorado — have even begun investing in inexpensive housing of their communities, citing the necessity to deal with what are generally referred to as social determinants of well being.

However as hospitals and different medical suppliers depart tens of millions in debt, they inadvertently undermine neighborhood well being, mentioned Brian Klausner, a doctor at a clinic serving homeless sufferers in Raleigh, North Carolina.

«Lots of the hospitals throughout the nation that are actually publicly vowing to deal with well being inequities and break down limitations to well being are concurrently serving to to create these very issues,» Klausner mentioned. «No one likes the elephant within the room, however the actuality is that there are literally thousands of sick People who’re possible homeless — and sick — due to medical debt.»

A downward spiral

Medical debt can undermine housing safety in a number of methods. For some, it depresses credit score scores, making it troublesome to get a lease or a mortgage. Final 12 months, about 1 in 8 U.S. customers with a credit score report had a medical debt listed on it, based on the nonprofit City Institute.

Sufferers with continual medical situations could fall behind on lease or house funds as they scramble to maintain medical money owed in test to protect entry to well being care. Many hospitals and different suppliers will flip away sufferers with excellent payments, KFF Well being Information discovered.

Denise Beasley, who additionally assists shoppers at CEDP in Denver, mentioned many older individuals, who usually rely most on physicians and drugs, imagine they need to pay their medical and pharmacy payments earlier than the rest. «The aged are terrified,» she mentioned.

For others, such debt can compound monetary struggles introduced on by an accident or sudden sickness that forces them to cease working, jeopardizing their well being protection or skill to pay for housing.

In Seattle, researchers discovered widespread medical debt amongst residents in homeless encampments. And people with such debt tended to expertise homelessness two years longer than encampment residents with out it.

Extra broadly, individuals with medical debt usually tend to say the debt has brought about them to be turned down for a rental or a mortgage than individuals with scholar loans or bank card debt, based on a 2019 nationwide survey of renters, homebuyers, and property house owners by actual property firm Zillow.

For Atencio, who left house at 16, his struggles with medical debt started with the center assault. He was working at a fuel station and residing in Trinidad, a small metropolis in southern Colorado close to the New Mexico border.

Rushed to an area hospital, he underwent surgical procedure. The payments, which topped $50,000, weren’t lined by his well being plan as a result of he’d unknowingly gone to an out-of-network supplier, he mentioned. «I fought it as onerous as I might, however I could not afford a lawyer. I used to be caught.»

Atencio, who’s transgender, has close-cropped darkish hair and a big tattoo on his proper forearm memorializing two associates who died in a automobile accident. Sitting on an growing old sofa in an condo with bars on the home windows, he is philosophical about his lengthy journey from that medical disaster via years of debt and housing insecurity. «We have pulled ourselves out of this,» he mentioned. «Nevertheless it took a toll.»

When Atencio’s credit score rating dipped near 300, the bottom score, there have been few locations to show for assist. Atencio’s relationship along with his mother and father, who divorced when he was 2, had been strained for years. Atencio obtained married at 18, however he and his husband not often had sufficient to make ends meet. «I keep in mind pondering, ‘What sort of a begin to my grownup life is that this?'»

They had been in the end taken in by Atencio’s mother-in-law. «If it wasn’t for her, we’d have been homeless,» he mentioned. However getting out from the debt was agonizing.

«You find yourself on this cycle,» he mentioned. «You get into debt. Then you definately take out loans to attempt to repay a few of the debt. However then there’s all this curiosity.» With poor credit score, Atencio relied at instances on payday lenders, whose excessive rates of interest can dramatically enhance what debtors owe. Many employers additionally test credit score scores, which made it troublesome for Atencio to land something however low-wage jobs.

The job on the shelter was a step up, and Atencio this 12 months obtained the condo, which is reserved for single-parent households susceptible to being homeless. (Atencio separated from his husband final 12 months.)

Colorado’s housing challenges

Atencio’s housing struggles are hardly distinctive. Jim and Cindy Powers, who stay in Greeley, a small metropolis north of Denver, noticed their very own housing desires collapse after Cindy was identified with a life-threatening situation that required a number of surgical procedures and left the couple with greater than $250,000 in medical debt.

When the Powers declared chapter, the settlement protected their house. However their mortgage was bought, and the brand new lender rejected the cost plan. They misplaced the home.

Lindsey Vance, 40, who moved to Denver 5 years in the past searching for extra inexpensive housing than the Washington, D.C., space the place she was from, nonetheless cannot purchase a home due to medical money owed. She and her husband have a six-figure revenue, however medical payments for even routine care that she’s struggled to pay since her 20s have depressed her credit score rating, making it troublesome to get a mortgage. «We’re caught in a holding sample,» she mentioned.

In and round Denver, elected officers, enterprise leaders, and others have turn into more and more involved about medical debt as they search for methods to deal with what many see as a housing disaster.

«This stuff are deeply linked,» Denver Metropolis Council member Sarah Parady mentioned. «As housing costs have gone up and up, I’ve seen an increasing number of individuals, particularly individuals with a medical points and money owed, lose housing safety.» Parady, who ran for workplace final 12 months to deal with housing affordability, helps lead an effort to get town to purchase and retire medical debt for metropolis residents.

Fueled by skyrocketing costs and rising rates of interest, the price of shopping for a house greater than doubled in Denver from 2015 to 2022, based on one current evaluation. And with rents additionally surging, evictions are rocketing upward after slowing in the course of the first two years of the pandemic.

Maybe nowhere is Denver’s disaster extra seen than on the streets. The town’s downtown is dotted with tents and encampments, together with one which stretches over a number of blocks close to the shelter and clinic the place Atencio used to work. By one depend, metro Denver’s homeless inhabitants elevated almost 50% from 2020 to 2023.

CEDP, which was based to assist residents with housing challenges sparked by the pandemic, this 12 months joined different Colorado shopper and affected person advocates to push the legislature for stronger protections for sufferers with medical debt.

And in June, Colorado enacted a trailblazing invoice that prohibits medical debt from being included on residents’ credit score stories or factored into their credit score scores, a transfer that put the state on the forefront of efforts nationally to broaden debt protections for sufferers.

A number of different states are contemplating comparable steps. And in Washington, D.C., shopper and affected person advocates are pushing for federal motion to restrict medical payments on credit score stories. In most states — together with many with the very best charges of medical debt — sufferers nonetheless haven’t any such protections.

For his half, Atencio is hoping the brand new condo marks a turning level.

The house is modest — a small unit in an growing old concrete tower. There is a safety guard by the entrance door and lengthy, linoleum corridors painted institutional blue and brown.

Atencio’s household is settling in, together with 4 pet rats — Sew, Cheese, Peach, and Bubbles — who stay in a big cage in the lounge. «This appears like freedom,» mentioned Atencio.

He is tried to offer his youngsters, who’re 5 and 11, a way of safety: home-cooked meals and the house to play or hand around in their very own bedrooms. Like mother and father in every single place, he frets over their display screen time and rolls his eyes once they critique what’s for dinner. (They did not just like the potatoes he put in a pot roast.)

They’re all full-time college students: Atencio, who left his job on the shelter, is engaged on a grasp’s in social work. His son simply began kindergarten, and his daughter is in center faculty. «I’ve huge plans and massive objectives,» he mentioned.

And with a number of thousand {dollars} of medical debt nonetheless to repay, Atencio mentioned he is cautious to not take his youngsters to an out-of-network hospital or doctor. «I will not make that mistake once more,» he mentioned.

About this mission

«Prognosis: Debt» is a reporting partnership between KFF Well being Information and NPR exploring the size, affect, and causes of medical debt in America.

The sequence attracts on authentic polling by KFF, court docket data, federal information on hospital funds, contracts obtained via public data requests, information on worldwide well being techniques, and a yearlong investigation into the monetary help and assortment insurance policies of greater than 500 hospitals throughout the nation.

Extra analysis was carried out by the City Institute, which analyzed credit score bureau and different demographic information on poverty, race, and well being standing for KFF Well being Information to discover the place medical debt is concentrated within the U.S. and what elements are related to excessive debt ranges.

The JPMorgan Chase Institute analyzed data from a sampling of Chase bank card holders to take a look at how clients’ balances could also be affected by main medical bills. And the CED Challenge, a Denver nonprofit, labored with KFF Well being Information on a survey of its shoppers to discover hyperlinks between medical debt and housing instability.

KFF Well being Information journalists labored with KFF public opinion researchers to design and analyze the «KFF Well being Care Debt Survey.» The survey was carried out Feb. 25 via March 20, 2022, on-line and through phone, in English and Spanish, amongst a nationally consultant pattern of two,375 U.S. adults, together with 1,292 adults with present well being care debt and 382 adults who had well being care debt up to now 5 years. The margin of sampling error is plus or minus 3 proportion factors for the total pattern and three proportion factors for these with present debt. For outcomes primarily based on subgroups, the margin of sampling error could also be increased.

Reporters from KFF Well being Information and NPR additionally carried out tons of of interviews with sufferers throughout the nation; spoke with physicians, well being trade leaders, shopper advocates, debt legal professionals, and researchers; and reviewed scores of research and surveys about medical debt.

This text was reprinted from khn.org, a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF – the unbiased supply for well being coverage analysis, polling, and journalism.