Double shifts, credit card debt and family loans when twins are born early

Allison Ward43 years old, Chicago

Approximate medical debt: $80,000

Medical problem: Childbirth

What happened: There were times after the birth of her sons 10 years ago, Allyson Ward wondered if she and her family were going to lose their home.

Some days she would check off a list of friends and family members, considering who could accommodate them. “We had a plan that we weren’t going to be homeless,” Ward recalled.

Ward is a nurse practitioner who works in a neonatal intensive care unit in Chicago. Her husband, Marcus, runs a small non-profit organization.

But when the couple’s boys, Milo and Theo, were born 10 weeks premature, their lives were turned upside down financially.

The twins were diagnosed with cerebral palsy. One of them required several surgeries to resolve a respiratory problem. The babies spent more than three months in a NICU.

Ward and her husband struggled to ensure the boys received the care they needed, including years of physical and occupational therapy. The bills, which totaled around $80,000, overwhelmed them.

At first, much of it came from hospital care. Then their health plan denied thousands of dollars in claims for the boys’ therapies, deeming some unnecessary.

Desperate, Ward and her husband loaded up on credit cards, borrowed from relatives and delayed student loan repayments. They moved back to the Midwest from Dallas to be closer to family who could help them.

In Chicago, Ward took on additional nursing shifts, working day and night several times a week. Her husband, who was finishing a master’s degree, watched the babies.

“I wanted to be a mom,” she said. “But we had to have the money.”

What is broken: Ward and her husband had health insurance through her employer in Texas.

But that’s often not enough to protect patients from a major medical event. Most Americans with medical debt had coverage, according to a KFF survey.

Even with health insurance, childbirth can be very expensive. One in 8 Americans who have health care debt say it was at least partially caused by pregnancy and childbirth.

Ward and her husband are also among tens of millions of Americans who end up with medical debt because their health plan didn’t pay for something they thought was covered. These insurance problems are the most common form of billing problem cited by indebted Americans.

What’s left: Since returning to the Midwest, Ward and her husband have been slowly paying off the debt.

They bought a small house in Chicago in 2016. And Milo and Theo were able to stay in school.

Although cerebral palsy can be severely disabling, the boys can run, cycle and rock climb, which Ward credits to the many therapists who have worked with them.

Ten years later, however, the family is still paying off nearly $10,000 in medical debt on their credit cards.

Ward said sometimes at work she would look sadly at new parents in NICU, thinking about their upcoming financial struggles. “They have no idea,” she said.

About this project

“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact and causes of medical debt in America.

The series is based on the “KFF Health Care Debt Survey”, a survey designed and analyzed by KFF public opinion researchers in conjunction with KHN journalists and editors. The survey was conducted from February 25 to March 20, 2022, online and by phone, in English and Spanish, among a nationally representative sample of 2,375 American adults, including 1,292 adults with health care debt. and 382 adults with health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other poverty, race, and health status demographics to explore where medical debt is concentrated in the United States and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed the records of a sample of Chase credit cardholders to examine how customer balances can be affected by large medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with doctors, healthcare industry leaders, consumer advocates, debt lawyers and researchers; and reviewed dozens of studies and surveys on medical debt.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.