Cancer was what finally pushed Kristi Reyes into living in her car.
The mother of four had worked all her life, starting at age 7 when she helped out at her family’s furniture store. Most of her work was in retail. It was paycheck-to-paycheck but she kept her kids together and a roof over their heads.
But then in 2012 she was diagnosed with breast cancer. She started cycling through jobs because of the time she needed to take off for recovery from treatment. Soon, she was too sick to work at all and things continued to slide. She had Medicaid, what she calls a medical card, but it wasn’t enough.
“Even though I had a medical card, there were out of pocket things that medical didn’t cover,” she said. “I don't care how much money you make,” she said. “Money is never enough when you're sick like that.”
She and three of her children, who were 11, 13 and 15, all stayed in the car for a while. But soon she was forced to let her children live with other people.
She remembers recovering from surgery to remove cancerous lymph nodes, homeless and alone. Eventually, she was too sick for treatment to even continue.
“I couldn't even walk up a flight of stairs without being out of breath, almost needing oxygen,” she said. Her diabetes was out of control. She was also having trouble with her kidneys.
But she said she knew other people who had it worse.
“At the same time, I think that was kind of something that kept me going. Right? Like knowing that somebody had it worse than I did.”
At least, she said, she had a car.
Housing and Health
In fact, her case is not unique. The National Alliance to End Homelessness estimates there are 15,000 people experiencing homelessness in Kentucky, West Virginia and Ohio. Many more are living on thin financial margins. The Robert Wood Johnson Foundation reported earlier this year that half of rural Americans say they could not afford to pay an unexpected bill of $1,000, and nearly a third say that they have had trouble paying medical bills.
Jessica N. Sucik directs homeless services for HealthFirst Bluegrass, a federally qualified health center in Fayette County, Kentucky. HealthFirst serves 25,000 patients, many of them poor. It also runs two health clinics for the homeless.
She said there is a saying in public health that “housing is healthcare.”
Just the nature of chronic illnesses such as diabetes or COPD can limit how much people can work.
“So they know they can't work permanently, 40 hours a week,” she said. “They're working as they can, but they also can't afford housing or whatever treatment they need to overcome their condition.”
Circumstances can change quickly.
“With chronic medical conditions, something temporary can very, very quickly turn into a permanent homelessness status,” she said.
That leads to challenges paying the bills. It can be an unrelenting cycle.
“Without that, it's like, you know, building a house on sand,” she said. ”You have to have that safety and that security blanket of safe, stable and affordable housing before you can take care of yourself and be able to meet your needs.”
In recent years, HealthFirst has adopted a team approach with all patients. There is a medical provider, a social worker, a case manager and psychiatrist to provide medical, psychological and social support instead of leaving patients to fend for themselves.
“The magic that happens when you address not just the physical health issues, but also the things that are preventing them from getting those physical health issues addressed, is really, that's where it's at,” she said.
But others say homelessness or personal bankruptcy due to medical costs point to a need for more systemic change.
One policy solution gaining traction among Democratic presidential candidates is Medicare for All, a proposal that would eliminate private health insurance and replace it with a government-run system. Leading contenders Sen. Elizabeth Warren and Sen. Bernie Sanders support such a proposal.
Warren estimates her proposed plan would cost $20.5 trillion above expected health care costs over ten years. She says that could be paid for largely with an increase in taxes on the top income brackets and through savings in medical costs, but that claim has met some skepticism from policy experts. Sanders has been less specific about the costs and has said his proposal would find savings through cutting administrative costs.
The Urban Institute has estimated that a switch to a single-payer system would require $59 trillion over 10 years, about $7 trillion more than the costs under the current system.
The debate over the impact of medical bills on bankruptcy has been going on for a decade. Dr. Steffie Woolhandler is co-founder of the advocacy group Physicians For A National Health Program, which argues for a single-payer system. Her group says research shows more than 60 percent of personal bankruptcies are tied to medical bills. She says a single-payer system can reduce costs and relieve families from going into debt, which is why many other countries have such a system.
“Virtually every other developed country guarantees health care to everyone living there,” she said. “This is true in Europe, it's true in Canada, and it's true in Australia. The United States is an outlier.”
She said the idea is gaining appeal in the U.S.
“What I'm seeing, really since 2016, is that the idea of Medicare for all has become an issue with non physicians and a lot of people who don't work in health systems but are users of that healthcare system are actually talking about Medicare for All,” she said.
Reyes doesn’t spend a lot of time considering such policy decisions. Taking care of herself and her family is about all she can handle.
For about four years from the time she was first diagnosed with cancer, she was struggling to keep her employment, living mostly in her car, and separated from her children.
She tried from time to time to get into a shelter but whenever she’d reach out, they were full. One day, she said, she couldn’t take it anymore.
“I was at my wit’s end. Like I didn’t know what else to do. I was tired, worn out. My body felt like I couldn’t handle it anymore,” she said. “Honestly, I just started praying.”
Finally, she found help and a new home.
She called the Salvation Army and was referred to the Housing and Homeless Coalition of Kentucky. Within two months, she was off the street.
Last year, she moved into a house in Frankfort, Kentucky, where she lives with her children, two grandchildren and her boyfriend. Because of her ongoing medical problems she has been approved for lifetime housing assistance and resumed her cancer treatment.
“That made it even better. Because I know no matter the struggles of my health, or the battles that I got to fight with it. I'm always going to have that support.”
About a month ago, she was well enough to start working at a Subway sandwich shop.
A simple, second-hand dining room table is her favorite place to be.
“That's the thing, that's my thing,” she said with a laugh. “Because I can come in, I can cook for my children. And we can sit at the table and have a meal together.”
Looking back, she said, she realizes now that she was in denial about just how bad her health was. And she hopes other people will take some comfort in knowing things can change for the better.
“You just have to tell yourself, ‘OK, I'm not going to give in today,” she said. “You know, people just need to know that just because you're going through things, it doesn't necessarily mean that you're going to be stuck there for a lifetime.”