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The story of a Kansas couple struggling to avoid bankruptcy over medical debt

A MARTÍNEZ, HOST:

Three out of every five American adults without health insurance have debt from medical or dental bills. That's according to a poll from the Kaiser Family Foundation. And one-quarter of these people think they will never be able to pay off that debt. Bram Sable-Smith with our partner Kaiser Health News takes us to Lawrence, Kan., to see how far one couple went to avoid bankruptcy.

BRAM SABLE-SMITH: Jeff King says he never got an estimate for how much the procedure to fix his heart rhythm would cost. And he did ask. He just knew he needed it sooner than later, so he got it done. A month later, he got $160,000 bill from the hospital. And because Jeff and his wife, Kareen, were uninsured, they were on the hook for all of that.

JEFF KING: We spent several weeks at that initial time, when we first got the bill, thinking that perhaps our only route is going to have to declare bankruptcy.

KAREEN KING: Oh, yeah.

SABLE-SMITH: The Kings have been on their own to find health coverage for pretty much their entire 42 years of marriage. Jeff spent most of that time as an evangelical pastor in his hometown of Osage City, Kan. The work almost never provided insurance for the family. The one exception was his last stint helming a congregation starting in 2015. The health plan costs $1,800 a month, and the congregation paid it all. Kareen remembers feeling unworthy.

K KING: We certainly had never come up with those kinds of premiums ourselves.

SABLE-SMITH: But Jeff left that job in 2018 when he says his views on eternal damnation and gay marriage became an issue. It was a painful time for him and Kareen.

K KING: I think we just feel like we're kind of thrown by the wayside a little bit, dismissed, deemed as a threat because my husband's views are more inclusive than some feel is theologically sound.

SABLE-SMITH: The Kings were trying to move on. For work, Jeff started a nonprofit providing spiritual guidance. For insurance, they initially got an Affordable Care Act marketplace plan. But, well, long story short, they lost that coverage.

J KING: So it put us in a real quandary. And that's why we're trying to scramble to find some kind of coverage to get us through.

SABLE-SMITH: The Kings chose something called a medical cost-sharing plan. It's sold as an alternative to insurance with roots in religious communities sharing medical expenses. It's not insurance, though. It offers fewer protections and will not necessarily cover bills. But the plans often have low premiums, so they've grown in popularity. The Kings said their plan would not cover preexisting conditions, like Jeff's heart issues, for the first two years. They knew it was a gamble, but...

J KING: At that time, my heart was cooperating. I hadn't had any trouble. It was all good, figured we'd get through the two years and - but I didn't make it.

SABLE-SMITH: And they ended up with that $160,000 bill. After months of negotiating the hospital's financial assistance program, Jeff's final tab was dropped to $40,000 - a lot less but still a lot of money for someone who spent his life as a small-town pastor. So Jeff did what 40% of Americans with medical debt do - he took on extra work. On top of running his nonprofit, Jeff became a hospice chaplain. We met up at his second job this June as he was driving out to a small graveyard in the Flint Hills of eastern Kansas. On the way, we pass the family compound where Jeff built a church from the ground up.

J KING: This road going south, this is my family's farm. That blue house over there is where we raised our children.

SABLE-SMITH: They sold that house last year, though, and moved to a smaller home in Lawrence, Kan. They're hoping to use that money to fund their retirement since Jeff's decades of working as a pastor never came with 401(k). Instead, the home sale was helping pay his hospital bill. They'll pay $500 a month for over six years, basically a second mortgage. When we get to the graveyard in the late morning, the son is cooking. Jeff greets the family of a hospice patient who passed away and leads her graveside service.

J KING: We're here today to help remember and keep alive the stories about Carolyn.

SABLE-SMITH: On the ride home, Jeff says he actually feels pretty lucky. Sure, he and Kareen are putting off their retirement for a bit, but 3% of Americans with medical debt end up declaring bankruptcy. He's thankful he did not become one of them. I'm Bram Sable-Smith in Lawrence, Kan.

MARTÍNEZ: That story is from NPR's partnership with Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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