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“My stress was off the charts.”

David Zipprich, 65, Fort Worth, Texas 

Approximate Medical Debt: More than $200,000 

Medical Issue: Diabetes and covid-19 

What Happened: David Zipprich, a Fort Worth businessman and grandfather, was forced out of retirement after a series of hospitalizations left him owing more than $200,000. 

Zipprich had spent a career in financial consulting. He owned a small bungalow in a historical neighborhood near the Fort Worth rail yards. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings, and he’d paid off his mortgage. 

In early 2020, though, Zipprich landed in the hospital. While he was driving, his blood sugar dropped precipitously, and he blacked out and crashed his car. 

Three months later, after he was diagnosed with diabetes, another complication sent him back to the hospital. In December 2020, covid-19 put him there again. “I look back at that year and feel lucky I even survived,” Zipprich said. 

What’s Broken: Of the nation’s 20 most populous counties, none has a higher prevalence of medical debt than Tarrant County, where Fort Worth is located. Second is adjacent Dallas County, credit bureau data shows. 

Nevertheless, Dallas-Fort Worth medical systems have been thriving. Though many are exempt from taxes as nonprofit institutions, several notched double-digit profit margins in recent years, outperforming many of the area’s Fortune 500 companies. 

A KHN review of hospital finances in the country’s 306 hospital markets found that several of the most profitable markets also have some of the highest levels of patient debt. 

Overall, about a third of the 100 million adults in the U.S. with health care debt owe money for a hospitalization, according to a poll conducted by KFF for this project. About a quarter of those owe $10,000 or more. 

“The fact is, if you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance,” said Allison Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors so patients won’t have to pay it. 

Overall in Tarrant County, 27% of residents with credit reports have medical debt on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute shows. In Dallas County, it’s 22.5% 

What’s Left: Even with insurance, Zipprich was inundated with medical bills, debt notices, and calls from collectors. 

As he struggled to pay, his credit score plummeted below 600, and he had to refinance his home. “My stress was off the charts,” he said, sitting in his tidy living room with his Shih Tzu, Murphy. 

Last year, Zipprich returned to work, taking a job in New Jersey that required him to commute back and forth to Texas. He recently quit, citing the strain of so much travel. He’s job-hunting again. “I never thought this would happen to me,” he 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 draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had 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 demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

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