Jeff Lucas and his wife live in a nice house in Jupiter, Fla., just one mile from the beach. He works from home, arranging financing for business owners. His wife, a nurse, works for a state health agency. They make good money, but they've got college bills for three kids and other rising costs. So they've cut back. They eat out less. They don't go so far away on vacation. They do their own housecleaning and yardwork now.
And Lucas, who's 49, says he's also cut back on medical care. He has been putting off dental work because the total isn't covered by his insurance.
"I've got a tooth missing on one side of my face," he says. He's been trying to get a temporary one, but his insurance company tells him he's already spent his limit. "So I say I'll just chew on my left side.""
He's not alone in that kind of decision-making.
In a new poll conducted in Florida and Ohio for NPR by the Kaiser Family Foundation and the Harvard School of Public Health, one in four people say they're having trouble paying their medical bills. Many are middle-class people with jobs and health insurance. And some even say they earn six-figure incomes.
According to the survey, 30 percent of people in Florida say they've put off needed medical care. And 41 percent in Florida say they've skipped dental care – just like Lucas.
"In previous years, I wouldn't have thought twice about just getting a procedure done if I needed it," he says. "And today if I'm faced with spending $500 or $600 to put a crown on a tooth, and if I feel that I can get by — if I could still eat fine without it — then I'm making the decision, hey, I'm just not going to get that procedure done."
In addition to postponing the care they need, 28 percent of Floridians say they ignored a doctor's advice to get a medical test or treatment. That's 11 percentage points more than when the same question was asked in a national poll three years ago.
Last November, Lynda Blankenship's doctor asked her to get a blood test. She was surprised when she was charged $900. Because of the high deductible on her health insurance, the 61-year-old in Massillon, Ohio, had to pay it all.
In March, her doctor asked her to repeat the test.
"And I just said, no, I'm not doing it. I'm not spending that," Blankenship says. "And she got kind of upset with me."
Blankenship is covered by the insurance her husband gets as a retiree from his former employer. But their premiums doubled this year: from $70 a month to $140.
"To me, it's a nightmare. The worst thing ... about getting older is that you remember how good it used to be," Blankenship says, recalling company-paid health care with no deductible. To younger people, "this may all seem normal. But to those of us who can remember that, we just feel we're being robbed."
So Blankenship has tried to be a good consumer and figure out what care and medicine she really needs and what seems like excessive ordering by her doctors.
"We do make individual informed or uniformed decisions about whether I can have that test or whether I can take that medicine," she says. "We have to make those choices all the time because our resources are very finite."
The NPR poll found that many people see their resources as finite when it comes to paying for health care. About 25 percent say they've recently chosen not to fill a prescription and about 20 percent say they've cut pills in half or skipped doses to save money.
Nearly half of the respondents with jobs say they'd gone to work when they were sick because they worried about the financial consequences of missing work.
Collection Agencies In Pursuit
The poll had another surprising finding: One in four people in Ohio and one in five in Florida say they've gotten collection agencies chasing them. The most common reason: unpaid health bills.
Kristin Hicks of Sarasota, Fla., was treated in a hospital two years ago. She thought her insurance company had paid all the bills. But this spring, Hicks received a $400 bill, followed shortly by a call from a collection agency.
"Bam, two years later you're still getting billed. And, God knows, maybe another year from now I'll get something else," Hicks says.
When people in the poll were asked what the government could do to get them through the economic downturn, helping with medical bills came in near the top.
Professor Robert Blendon, who runs opinion research programs at the Harvard School of Public Health and who worked on the poll, says that's striking.
"This fact of seeing health care support as an economic solution has not shown up in any other poll, and that is really a surprise," says Blendon.
When people were given a list of things government should do, help with medical bills ranked second in Ohio and third in Florida. That was just behind stopping jobs from going overseas and pulling out of Iraq, but ahead of tax cuts, stimulus checks or increased spending on domestic programs and public works.