MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. We hear from remarkable people every day but over the next few days we are going to hear from two especially courageous young women. Elizabeth Smart will be with us later today. You might remember her as the young girl who was kidnapped and held captive for nine months. Now she's written a memoir about what happened. It's called "My Story". That's coming up later.

But first, we head to Mississippi where a new report says that more than half of the people in the state who file for bankruptcy, some 57 percent, do so because of medical bills. That's for both insured and uninsured Mississippians. We first saw that in a story by investigative reporter, Jerry Mitchell. He writes for the Clarion-Ledger in Jackson, Mississippi. He's also a previous winner of a MacArthur Fellowship, a so-called genius grant. We caught up with him in Tulsa, Oklahoma where he's on the road reporting. Jerry Mitchell, welcome back to the program. Thanks so much for joining us once again.

JERRY MITCHELL: Thank you, good to be with you.

MARTIN: Now the report comes from NerdWallet. That's a personal finance website and it makes the point that, you know, millions of Americans all over the country are struggling with high medical bills. But it says that of the estimated 12,060 bankruptcies being filed this year in Mississippi, 57 percent involve medical bills. Why is that number so high, do we know?

MITCHELL: Well, medical bills, as we all know, have increased over the years and it takes an increasing amount too, of the percentage of our income. Obviously, around the country, but I think it's especially hard-hitting in Mississippi. In Mississippi in the early '90s medical, in terms of cost, total cost including what we pay in taxes and things like that, someone in Mississippi in the early '90s was something like a seventh of your income would go toward healthcare medical costs. Today it's approaching a fourth. In other words, one out of every $4 that you have in your pocket go toward healthcare medical costs.

MARTIN: Why is that?

MITCHELL: The healthcare costs are just going up every year and what you see now, just since 2009, medical deductibles that the companies, you know, private insurance I'm talking about, have doubled just within a few years. So both in network and out of network both those deductibles have doubled and a lot more companies are going what you might - toward what you might call catastrophic care. You've got insurance but they're not going to pay co-pays or anything else, it's just going to be just to make sure that you don't get wiped out.

MARTIN: So that would explain why people - 'cause I think many people might wonder why it is that even if you have insurance...

MITCHELL: Correct.

MARTIN: Medical bills play such a big role in financial distress. Now in your story in the Clarion-Ledger, Jerry, you spoke with a number of people and you spoke with Amanda Brewer (ph) from Carrollton, Mississippi. She's a working mom. She does work but she doesn't have health insurance. Last year, her son broke his femur in her backyard.

MITCHELL: Right.

MARTIN: Here she is talking about calling the hospital and first discovering how much the bill would be.

AMANDA BREWER: So she pulls it all up and she's like, oh, your bill is $40,000. And I bust into tears, squalling, you know. And I'm like, well, the (unintelligible) didn't tell me I don't qualify for financial assistance. What am I going to do?

MARTIN: So what did wind up happening with her?

MITCHELL: Well, she's still trying - struggling to pay those bills. She's trying to pay $50 a month to the hospital bills. She was able to negotiate them down to 18,000. But they wanted all their money in a year. And she's like, I'm a single mom, I'm working. I can't afford, you know, that much in one year. 18,000 in one year? And then she also got a bill from the ambulance. See her son was transported locally to Greenwood, Mississippi and then transferred from there to Jackson. And so the ambulance bill on that was like $2,400. And she actually got a bill from the collection agency before she actually got a bill from the ambulance.

MARTIN: Well, that's my - that kind of leads to my next question which is - is there something in the way these issues are administered? Is there something in the law in Mississippi that additionally works to push people into bankruptcy in addition to the high costs themselves?

MITCHELL: Well, I think people are poorer in Mississippi. They live closer to the ground. And so therefore you have a lot more working poor in Mississippi. People that kind of fall between the two, you know, having being taken care of in terms of let's say Medicaid and things like that and even people - Medicaid don't have all the costs paid. So you have them falling in between the two. You know, they - more and more companies now in Mississippi are not offering private insurance and yet obviously our state is opting out of being any part of the Affordable Care Act.

MARTIN: I was going to ask you about that. Two elements of that - one is, is there a role that chronic conditions play in this...

MITCHELL: Absolutely.

MARTIN: ...Because we talked about this - in Amanda's case, this was an accident.

MITCHELL: Yeah. Exactly.

MARTIN: But what about the whole role of chronic conditions? And secondly, I did want to ask you if you would follow up on this whole question because Mississippi is one state that has - whose political leadership has opted not to expand Medicare under the Affordable Care Act.

MITCHELL: Correct.

MARTIN: And so I want to know if anything will change in the state despite the decision by the political leadership not to participate.

MITCHELL: You know, unless citizens rise up and say we want this and demand this, I don't see it changing. I think the leadership is now very much in control of those who oppose Affordable Care Act, oppose expansion of this, and you're exactly right. These kind of - some of these issues would be handled by the Affordable Care Act and attempt - certainly, Affordable Care Act attempts to address a lot of these situations that we're talking about.

But you make an excellent point about the chronic care 'cause I know someone personally, and they have a very expensive medicine. And their healthcare plan just changed this coming year. And so they had a co-pay on medicine that they use for their expensive medicine. Now that's gone away.

That's what I was saying, more and more companies are going more and more catastrophic. So they're going to be out-of-pocket, you know, thousands and thousands of dollars. I mean, that's...

MARTIN: And if we could also ask about the whole question of excess weight or obesity. I think many people...

MITCHELL: Yes.

MARTIN: ...Might be familiar with the fact that there are sort of obesity hotspots around the country...

MITCHELL: Well, we're one of them.

MARTIN: ...And Mississippi is one of them. Is it - I'm interested in that. Is there kind of an interactive effect between...

MITCHELL: There is.

MARTIN: ...The chronic conditions and the cost issue?

MITCHELL: There is. Absolutely because what you see - and it's not just Mississippi, but if you look at a map - and it's fascinating - the obesity rates around the country over the past 20 or 30 years has just skyrocketed, and it's been the worst in Mississippi. So what that means - one estimate I read is that by the year - when I was talking about percentage of cost about how, in Mississippi, we're approaching one out of four dollars going to healthcare cost. If obesity - current obesity trends continue - this is nationally - what we will spend - one out of three dollars on healthcare costs.

MARTIN: Is that primarily driven by chronic conditions or medical conditions related to obesity?

MITCHELL: Yes. That's what I'm talking about because what happens is - I'll give you an example. In Mississippi, you're poor, you don't - you know, you're not getting the checkups like you need, you're working poor you don't - and so they don't catch the fact that you have high blood pressure. They don't catch the fact that you've got high blood sugar. You're not tested for that. Then that has its effect on your kidneys over time and, you know, and other organs of your body. And so your kidneys can shut down. And so then you're on dialysis for the rest of your life -like with high blood pressure, you know.

MARTIN: So you're saying that a lot of people avoid...

MITCHELL: Exactly.

MARTIN: ...Medical treatment because they don't have insurance or the cost of accessing the insurance is so high that by the time they do present for care, they're in serious conditions.

MITCHELL: Exactly and then it ends up costing us way more than if they had preventative care on the front end, which is much cheaper - way, way cheaper than dialysis, which is like $100,000 a year or something like that.

MARTIN: Do the bankruptcy laws incentivized, though? That is one question I have is bankruptcy laws do vary from state to state. Is there an incentive to declare bankruptcy in Mississippi? Could that be one factor in why so many people do?

MITCHELL: Yeah. Well, I think what it is, is I think these medical costs exacerbate that, you know. People - but certainly, if you have a catastrophic event or even now, we're talking about like someone having a broken leg. I mean, that's what she said - Amanda Brewer said, the people that were - the hospital was demanding this money after one year. And she just said - I think it was actually the ambulance service - she said, you know, would you rather I declare medical bankruptcy? And those are the kind of choices. And so what people are doing is they're not going to the doctor. They're not taking drugs. They're, like, saying, oh, OK, I can't afford this medicine. So they're either not taking the medicine or not filling the prescription, or they're choosing an inferior medicine that doesn't really work as well. I talked to someone that had multiple sclerosis - same kind of issue that way.

MARTIN: Finally, Jerry, we only have about a minute and a half left. But I understand that another investigative reporter at the Clarion-Ledger, Emily Le Coz, has been looking at hospital billing.

MITCHELL: Yes, she has.

MARTIN: And she has a list of tips to save money on your hospital bills or if you find yourself in this difficult, you know, situation. Could you share some of those - some of the results of that reporting with us as well?

MITCHELL: Well, basically, that you shop around. It's - Emily did an excellent job kind of talking about how that - she compared if you were going to hospital, she compared it to going to the grocery store and buying - what would you think if you went in and milk was priced at $11 - a gallon of milk for $11? But that was not the price you paid unless you pay cash. And so it just makes no sense - it's like you would go in the grocery store - It's priced at $11 but nobody would actually pay that or expect to pay that unless you just walked in and paid cash.

MARTIN: So what's she's saying is that you can actually negotiate more of this than you might believe that you can.

MITCHELL: Absolutely. The sticker price, so to speak, when you go to hospitals is like way out of proportion to what the actual cost is. But most - a lot of people don't know that. Let's say they don't have insurance. They don't realize you can come in on the front end and negotiate. That's the thing that you have to do.

That's one of the tips - is, you know, talk to the hospital. If you know you're going to have surgery or procedure or things like that, go in and talk to them on the front-end and say, hey, you know, I don't have insurance. I want to talk to you. I want to see if I can negotiate cost and you can compare hospitals. And that's one thing we have online, is you can actually look at the hospitals, what their costs are and compare them. And I think you're going to see more and more push for transparency in medical cost and obviously that's something that needs to happen.

MARTIN: Jerry Mitchell is an investigative reporter for the Clarion-Ledger in Jackson, Mississippi. We actually caught up with him on the road in Tulsa, Oklahoma where he's on a reporting trip. Jerry Mitchell, thank you so much for speaking with us.

MITCHELL: Thank you. Transcript provided by NPR, Copyright NPR.