All in all, she was just grateful that she still had transportation.
But as a place to sleep, Leticia De Alegria’s car left a lot to be desired.
“I’ve stayed in it a couple of times,” said the Tulsan, who has faced the possibility of being homeless more than once in the past few years.
“I couldn’t sleep in my car, though. I was afraid someone would break in. I just didn’t know. It was heartbreaking for me to be in that situation.”
Thankfully, De Alegria has now moved in with a family member.
But her overall financial situation has not changed.
“I just don’t know what’s going to happen,” she said, adding that it feels like the hard times are here to stay.
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De Alegria, whose downward spiral began with a workplace injury, is one of countless Oklahoma residents who have felt the weight of medical debt.
The state is among the worst in the country for unpaid medical bills, which are particularly harsh on the most vulnerable sections of the population.
According to a recent Urban Institute report, nearly 22% of Oklahoma residents have medical debt in collections. That’s the third highest rate nationwide, behind South Carolina and West Virginia. In Oklahoma’s Communities of Color, the number rises to 32%.
As for the two most populous counties in the state, in Tulsa County, 19% of residents overall (32% communities of color) have medical debt in collections; in Oklahoma County it is 22% (35% communities of color).
Harmon and Greer counties in southwestern Oklahoma lead the state with 42% and 39% of residents, respectively, and are in the top 10 counties nationally for which figures are available.
No one is more aware of the problem than the organizations that serve the state’s most vulnerable residents.
“At least once a day now I see someone who has a medical debt problem. It seems to be becoming a bigger problem,” said Veronica Robles, case manager at the Tulsa Catholic Charities Emergency Relief Program.
“So often it comes on top of everything else they’re already dealing with.”
Medical debt is also a common concern among Green Country Habitat for Humanity’s client families, said Cameron Walker, President and CEO.
“Where we’re seeing it impact not so much on the front end, but after they own a home and pay a mortgage,” said Walker, whose nonprofit helps low-income families build their own homes.
Often medical bills are part of a “bundle of debts” that customers face, along with student loans, high-yield car loans, etc., he said.
“Our families are on such tight financial budgets that they are often just one major life event away from going completely haywire.”
When this event occurs, it is often medical.
“It’s not the fault of the homeowners themselves,” he added. “It’s not a misallocation of funds. There is simply a lack of excess funds.”
Oklahomans have not been idle in the face of the issue.
A recent Tulsa-based partnership with RIP Medical Debt, a national nonprofit, raised funds to help over 36,000 people in Oklahoma pay off nearly $41 million in medical debt.
But how to stop families from accumulating this debt remains a problem with no apparent solution.
Leaders are hoping the expansion of Medicaid — which Oklahoma passed unlike some other top-tier states — will help.
Since the July 2021 enactment, more than 300,000 Oklahoma residents have received coverage.
It’s too early to see any impact on medical debt numbers. But promisingly, the percentage of Oklahomans without insurance has fallen from 14.4% to 9.6% since Medicaid’s expansion, according to the Oklahoma Policy Institute.
De Alegria, who moved to Tulsa from Tucson in 2019, has always taken pride in working and supporting herself.
But almost overnight, her life in her new city was turned upside down.
She was injured on the job, resulting in three separate surgeries.
Now, although she has made an overall recovery, she has physical limitations that have made it impossible for her to find work.
To make matters worse, De Alegria did not have health insurance at the time.
And so far, while still pending, attempts at disability and disability benefits have been frustrating.
The end result, she said, is a financial nightmare involving thousands of dollars in medical debt.
Peter Chacon, emergency response manager at Catholic Charities in East Oklahoma, says the organization tries to intervene before medical debt becomes a problem and help households sign up for insurance.
“The bigger problem behind unpaid medical bills is unpaid bills, period,” he said. “Customers must choose between paying current bills for basic needs and getting insurance coverage for potential future medical bills. And they choose to meet their most time-sensitive needs first.”
Customers without insurance are more likely to avoid preventative care, which in turn leads to much higher bills when care is eventually sought, he said.
The average cost of a three-day hospital stay is about $30,000 — “more than the full year’s income of someone at or below the poverty line,” Chacon said.
“So for impoverished households it is a question of financial triage. A massive expense that there is no realistic possibility of repaying becomes the lowest priority for households with financial problems. Would you pay your $400 savings for a $30,000 medical bill and not dent or buy a new set of tires to drive to work? Or pay your utility bills?”
“It’s all just snowballs”
The medical debt issue wasn’t the only reason, but it was definitely a factor in Green Country Habitat becoming a HUD-approved homeowner consulting agency, Walker said.
“We wanted to have additional tools available to help customers with their debt,” said Walker, whose organization has built 100 homes over the past 22 months, most of which serve people of color in North Tulsa.
Walker said that over 50% of the organization’s client households have a single head, in most cases a single mother.
A topical situation for one of them, he said, has become all too commonplace.
“We have a household with a single mother who has a seriously ill child. She had to miss work and with out-of-pocket medical expenses, she defaulted on her mortgage payments.”
Habitat has been able to step in on behalf of customers in many mortgage cases, Walker said.
“We can kind of step in and be that intermediary between the bank and the family, and we can usually work with them, either change or buy some time,” he said.
“But I can tell you from experience that many families are panicking. You’re dealing with all of these things, maybe with a kid in the hospital. You are scared. So they don’t reach us and everything is just a snowball.”
Medical debt is often a factor and an added stressor. And with the current inflation, the picture is not getting any better for customers.
“We’re dealing with increased fuel costs, more food and increased energy costs,” Walker said.
“This is a real issue and we are making a real effort to speak to funders and people in the philanthropic community right now.”
While her future remains uncertain, De Alegria is grateful for the philanthropic spirit she encountered in Tulsa.
It starts with Robles and Catholic charities that continue to be there for them, providing them with food and various services.
“You’ve done so much for me,” she said.
Without the help of the charity and family members who took her in, she is afraid to think about what could have happened.
“I’d probably be under a bridge,” she said.
“It’s just so hard to think about how all of this could have happened to me.”
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