Intended for healthcare professionals


Illness should not inflict financial ruin

BMJ 2020; 368 doi: (Published 05 February 2020) Cite this as: BMJ 2020;368:m327

Linked Research

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the US

  1. Adam Gaffney1 2
  1. 1Harvard Medical School, Boston, MA, USA
  2. 2Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02138, USA
  1. agaffney{at}

Moving slowly forward in the US

A recent news report told the story of Shirley Perry, a nurse who worked at a large hospital before she got sick and lost her job—which also meant she lost her health insurance.1 When she returned to her hospital for healthcare, she ran up large medical debts that her previous employer sought to recover by suing her—for some $250 000 (£192 200; €227 200).1 The hospital also took out a lien on her home, which it auctioned off after her death at age 51.1

So it goes for the uninsured in America. Americans who are uninsured go without needed healthcare,2 and also face premature death.34 However, as Perry’s story illustrates, lack of coverage can also lead to financial ruin—a point emphasized by a valuable new study by Gotanda and colleagues in The BMJ (doi:10.1136/bmj.m40).5

Some 30 million people are uninsured in the United States today, although the problem was worse before the Affordable Care Act (ACA). That landmark health law reduced the number of uninsured by 20 million, mostly by expanding eligibility for Medicaid, a public insurance program for low income individuals. However, the Supreme …

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