The ripple effect of medical bills is something Durham resident Kerry Holbrook knows all too well.
"Anybody who has ever had cancer and gone to treatment knows that once you have cancer, you are bankrupt," she said.
She's had breast cancer and too many surgeries to count. Now she's overcoming hearing impairments and mental health challenges. For years, she worked two part-time jobs without health insurance.
Holbrook estimates she has hundreds of thousands of dollars of medical debt but she's lost count.
"We just laughed about how we stacked our bills up on the table. And then we threw it in the trash. Because what else are you gonna do with it?" Holbrook remembered.
There isn't any relief in sight for Holbrook but her needs don't stop. Recently, she had to open a credit card to afford new hearing aids.
"I couldn't do $7,000, you know? I mean, how am I supposed to pay for that? And so I opened up the credit card and from there you know, I mean, it just it's a ripple effect," she explained.
She isn't the only one facing mounting bills. When people can't pay their bills, their credit suffers and it goes on to impact other facets of their lives.
"It makes you feel bad; it makes you feel like you can't take care of yourself," Holbrook said.
Lower credit scores and high medical debt are both plaguing southern states.
A 2021 JAMA study found some patients in primarily southern counties can face medical debt six times higher than in other areas of the country.
The Urban Institute estimated the average medical debt in collections for North Carolinians is $757. Along the same lines, the institute reported the average credit score in the state is 2% lower than the national average.
The 2021 JAMA study found medical debt decreased by 44% between 2013 and 2020 in states that expanded Medicaid as opposed to only a 10% drop in states that did not.
The burden of medical debt is something Rev. Mindy Douglas, the pastor at First Presbyterian Church, is trying to lessen in North Carolina.
Last year her congregation started a campaign with RIP Medical Debt and was able to help pay off $5 million of medical debt for North Carolina patients. While the church hopes to raise money for another medical debt campaign soon, Douglas said, she is hoping lawmakers finalize Medicaid expansion soon.
"This is something that we as a church community have been pushing for a long time because we need to take care of the health care of all of the people not just some of the people," Douglas said. "There too many people who are not going to the doctor when they need to, who are not receiving significant treatments that they need to, who are not having the medications that they need, because they can't afford it."
As North Carolina leaders inch closer to finally expanding Medicaid, their final passage won't eliminate the buildup of future debt.
April Cook, CEO of the North Carolina Association of Free & Charitable Clinics, said around 700,000 people will still be left uninsured across the state.
"Medicaid will take care of individuals up to 138% of federal poverty, that those that are living at 139% to 250% are the working poor," Cook explained. "A single person making $19,000 will not qualify for Medicaid."
She said that is where the 71 free and charitable clinics across North Carolina will be needed. One of those clinics is Alliance Medical Ministry in Wake County.
"We have a waiting list of patients to begin with us. We're at capacity," explained Alliance Medical Ministry executive director Pete Tannenbaum.
The clinic provides holistic care to uninsured patients to help prevent their conditions from leading to major needs and subsequently large bills. Tannenbaum said they have around 2,200 patients but the need is growing.
"If we're not able to expand our patients, more than half they would either not receive care or they would go to the emergency room for basic primary care. Our patients have chronic diseases that are treatable. And that's what we do," Tannenbaum said.
Cook estimated the free and charitable clinics across the state saved hospital systems $369 million from emergency room diversion costs.
"The association saw about 100,000 uninsured folks last year if there's 700,000 remaining our work is still we've got a job to do," Cook said.
While the clinics have received funding over the past few years through COVID relief funds, continual funding will be needed.