Knoxville's Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt
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6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…1/17Diagnosed with cancer five years ago, Monica Reed of Knoxville, Tennessee, was le± with nearly $10,000 in medicalbills she couldnʼt pay. She has sacrificed, including cutting back on food. “You just do without some things to payother things,” she says. (JAMAR COACH FOR KHN AND NPR)DIAGNOSIS: DEBTKnoxville’s Black Community Endured Deeply RootedRacism. Now There Is Medical Debt.By Noam N. LeveyOCTOBER 28, 2022Stay informed.Sign up for our free daily news email.Subscribe now×
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…2/17Jamar Coach for KHN and NPRshots - health newsWhy Black Americans are more likely to be smedical debtlistenBy clicking “Accept All Cookies” or continuing, you agree to the use of cookies,similar tracking and storage technologies, and information about your deviceto enhance your viewing, listening and user experience, personalize content,personalize messages from NPR’s sponsors, provide social media features,and analyze NPR’s traffic. This information is shared with social media,sponsorship, analytics, and other vendors or service providers. You maycustomize which cookies you accept in "Cookie Settings."Cookies SettingsAccept All CookiKNOXVILLE, Tenn. — When Dr. H.M. Green opened his new medical officebuilding on East Vine Avenue in 1922, Black residents of this city on theTennessee River could be seen only in the basement of Knoxville GeneralHospital. They were barred from the city’s other three medical centers.Green, one of America’s leading Black physicians, spent his life working to endhealth inequities like this. He installed an X-ray machine, an operating room,and a private infirmary in his building to serve Black patients. On the first floorwas a pharmacy.This story also ran on NPR. It can be republished for free.About This Project“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causesof medical debt in America.READ MOREStay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…3/17Today the Green Medical Arts Building has been replaced by a tangle offreeways that were built after the city’s Black business district was bulldozed ina midcentury urban renewal project.But the health gaps Green labored to narrow still divide this community. And ifsegregation is less apparent in medical offices today, its legacy lives on incrushing medical debt that disproportionately burdens this city’s Blackcommunity.In and around Knoxville, residents of predominantly Black neighborhoods aremore than twice as likely as those in largely white neighborhoods to owemoney for medical bills, Urban Institute credit bureau data shows, one of thewidest racial disparities in the country.That tracks with a disturbing national trend. Health care debt in the U.S. nowaffects more than 100 million people, a KHN-NPR investigation found. But thetoll has been especially high on Black communities: 56% of Black adults owemoney for a medical or dental bill, compared with 37% of white adults,according to a nationwide KFF poll conducted for this project.The explanation for that startling disparity is deeply rooted. Decades ofdiscrimination in housing, employment, and health care blocked generations ofBlack families from building wealth — savings and assets that are increasinglycritical to accessing America’s high-priced medical system.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…4/17Central Street and Vine Avenue, pictured in 1949, was the heart of the Black business district inKnoxville, Tennessee, with grocers and pool halls, a YMCA, and the Gem Theatre, where BillieHoliday played. (BECK CULTURAL EXCHANGE CENTER IN KNOXVILLE, TENN.)Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…5/17Against that backdrop, patients suffer. People with debt avoid seeking careand become sicker with treatable chronic conditions like diabetes or multiplesclerosis. Worse still, hospitals and doctors sometimes won’t see patients withmedical debt — even those in the middle of treatment.“African Americans don’t seek health care until we are really, really sick, andthen it costs more,” said Tabace Burns, a former emergency room nurse inKnoxville. Burns, who is also a leader in her church, said she routinely helpsmembers of her congregation find medical care they should have soughtearlier.Nationwide, Black adults who have had health care debt are twice as likely aswhite adults with such debt to say they’ve been denied care because they owemoney, the KFF poll found. Many Black Americans also ration their care out offear of cost.Today a tangle of freeways stands where Knoxvilleʼs Black business district thrived a century agoat Central Street and Vine Avenue. In the late 1950s, the city razed hundreds of Black homes andbusinesses for urban renewal. (JAMAR COACH FOR KHN AND NPR)Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…6/17Big Racial DisparitiesBlack adults are much more likely than white adults to have health care debt and more likely to su±erserious consequences.WhiteBlackNote:*Share of adults with current debt who say they or someone in their household has experienced this over the past five yeSource: KFF Health Care Debt Survey of 2,375 U.S. adults, including 1,674 with current or past debt from medical or dental billsthrough March 20. The margin of sampling error for the overall sample is 3 percentage points.Credit: Alyson Hurt/NPR and Noam N. Levey/KHN0%25%50%75%37%10%17%10%37%56%19%30%20%56%Has current health care debtDenied care because of debt*Taken out a loan because ofhealth care debt*Changed living situation becauseof debt, such as moving in withfriends or family*Contacted by a collection agency*Burns recalled a friend who came to see her about an oozing growth on herbreast. “She didn’t have any insurance, so she just thought it would get better,”Burns said.Burns helped the woman find an oncologist to treat what turned out to becancer. There was a cost to waiting so long, though. Because the cancer wasso advanced, the friend had to undergo chemotherapy and have both breastsremoved.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…7/17It could have been worse. “What if she didn’t know me? What if she justcontinued to let her breast leak and it was necrotic?” Burns said. But, sheadded, if her friend hadn’t been so worried about going into debt, she wouldhave gone to the doctor sooner.It’s a terrible cycle, said Berneta Haynes, a staff attorney at the NationalConsumer Law Center. “This legacy of segregation and structural racismunderlies the racial health gap,” she said. “It impacts health outcomes andaccess. And it impacts the level of medical debt.”EMAIL SIGN-UPSubscribe to KFF Health News' free Weekly Edition.In ‘The Bottom’The story of how Knoxville’s Black residents came to be its primary victims ofmedical debt is written in the city’s changing landscape.Just outside downtown, below refurbished office buildings and formerwarehouses, is an area once called The Bottom, long the heart of the Blackcommunity.This area persevered through decades of Jim Crow segregation and violence.In one of the worst episodes, mobs of white rioters in 1919 vandalized Black-owned stores and shot residents after a young Black man was accused ofkilling a white woman.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…8/17It was here that Black physicians like Green opened medical offices alongsidegrocers, pool halls, and funeral homes. Knoxville’s first Black millionaire, aformer enslaved man who’d made a fortune in horse racing and saloons, builta YMCA. Billie Holiday and Cab Calloway performed at the Gem Theatre.Dr. H.M. Green was a leading Black physician in the early 20th century who fought discrimination inhealth care. His clinic was torn down when Knoxville, Tennessee, bulldozed Black neighborhoodsduring a midcentury urban renewal project. (BECK CULTURAL EXCHANGE CENTER IN KNOXVILLE,TENN.)Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…9/17Beginning in the late 1950s, the city systematically wiped out The Bottom andsurrounding neighborhoods in an urban renewal and highway-buildingcampaign. Officials razed more than 500 homes, 15 churches, and more than100 Black-owned businesses, including Green’s medical building.More than 2,500 families were displaced. Many ended up in public housingprojects. Others left Knoxville. Businesses never reopened. “It changed thewhole landscape,” said the Rev. Reneé Kesler, director of the Beck CulturalExchange Center, a nonprofit that preserves Knoxville’s Black history. “You’llhave generations that won’t recover from that.”What urban renewal left behind in East Knoxville was a neighborhood that’sthe poorest in the city — and has the largest share of Black residents.A tiny fraction of residents are homeowners. Blocks are blighted by boarded-up buildings and overgrown lots. Down the street from Knoxville’s oldest Blackcemetery, a Dollar General recently closed — one of the few stores aroundthat sold groceries.The neighborhood’s residents are sicker than those elsewhere in Knoxville,with higher levels of diabetes and other chronic illnesses. They are less likelyto have health insurance.They also have much more medical debt.More than 30% of the people have a medical bill on their credit record,according to credit bureau data collected by the nonprofit Urban Institute. Afew miles west in Knoxville’s overwhelmingly white suburbs, fewer than 10%carry such debt.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…10/17Medical Debtʼs High Toll in Knoxvilleʼs Black CommunitiesIn Knox County, Tennessee, areas with the highest share of Black residents also have the most medicaIt’s not difficult to understand the difference, said Eboni Winford, a clinicalpsychologist at Cherokee Health Systems, a network of clinics that serve low-income patients. “Black people are less likely to have generational wealth topass on, which means we don’t have the pockets of money that we can justuse if medical bills arise.”Nationally, the median white family now has about $184,000 in assets such ashomes, savings, and retirement accounts, according to an analysis by theFederal Reserve Bank of St. Louis. The assets of the median Black family totaljust $23,000.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…11/17“What happened is we concentrated Black poverty,” said Gwen McKenzie, aKnoxville City Council member who grew up not far from The Bottom. “Fromthere, that’s where it became generational.”‘Always a Sacrifice’Monica Reed lives just up the hill from where The Bottom once was.She considers herself luckier than most. Born in Knoxville and raised by asingle mother, Reed became the first in her family to own a home, a smallhouse built after the city demolished The Bottom. For the past 15 years, she’sworked for a faith-based nonprofit that assists low-income residents ofKnoxville.Midcentury urban renewal and highway-building in Knoxville, Tennessee, wiped out the Black businessdistrict and neighborhoods like The Bottom. “We concentrated Black poverty,” says city councilmember Gwen McKenzie. (JAMAR COACH FOR KHN AND NPR)Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…12/17“It hasn’t always been easy,” said Reed, who just turned 60. She raised herson by herself. And though she’s always worked, her modest salary madesaving difficult. “I just tried to live a frugal kind of life,” she said. “And by thegrace of God, I didn’t become homeless.”She couldn’t escape medical debt, though. Diagnosed with cancer five yearsago, Reed underwent surgery and chemotherapy. Although she had healthinsurance through work, she was left with close to $10,000 in medical bills shecouldn’t pay.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…13/17She’s been pursued by debt collectors and even taken to court. That’s forcedReed to make difficult choices. “There’s always a sacrifice,” she said. “You justdo without some things to pay other things.”Reed said she cut back on trips to the grocery store: “I don’t buy a lot of food.Just plain and simple.”She has adjusted, she said. “You just do what you have to do.” What angersReed, though, is how she’s been treated by the cancer center where she goesfor periodic checkups to make sure the cancer remains in remission. Whenshe recently tried to make an appointment, a financial counselor told her shecouldn’t schedule it until she made a plan to pay her bills.“I was so upset, I didn’t even find out how much I owed,” Reed said. “I mean, Iwasn’t calling about a little toothache. This is something that affects someone’slife.”Locking In DisparitiesHealth insurance gains made possible by the Affordable Care Act havenarrowed some racial health disparities, studies show.The expansion of Medicaid, in particular, has brought new financial security tomillions of low-income Americans. In a recent analysis of credit bureau andcensus data, researchers estimated that Medicaid expansion helped enrolleesavoid more than $1,200 in medical debt.But many of those gains have remained out of reach in Knoxville. Tennesseeis among 12 states that have rejected federal funding to expand the Medicaidsafety net through the 2010 health care law.Monica Reed lives just up the hill from where The Bottom once was. (JAMAR COACH FOR KHN AND NPR)Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…14/17Eight of the 12 are Southern states with large Black populations. The decisionnot to expand has disproportionately affected communities like East Knoxvillethat are already contending with deep racial disparities in health and wealth.Of the roughly 2.2 million people locked out of health coverage because thesestates rejected Medicaid expansion, nearly 60% are people of color, accordingto a KFF analysis. About a quarter are Black.Locked out of health insurance, many just try to hang on until they becomeeligible for Medicare, said Cynthia Finch, an advocate in Knoxville who hasworked to improve health in the city’s Black community. “People pray theydon’t get sick before they are 65,” she said.If Black patients go into debt, they face yet another challenge: a medical debtcollections industry that targets Black debtors more aggressively than theirwhite counterparts, particularly for smaller debts.About 6 in 10 Black adults with medical debts under $2,500 say they orsomeone in their household has been contacted by a collection agency in thepast five years, the KFF poll found. By contrast, only about 4 in 10 white adultswith similar debt said the same.At the courthouse in downtown Knoxville, the dockets are filled with debtcollection lawsuits filed by some of the region’s largest hospitals: Fort SandersRegional Medical Center, East Tennessee Children’s Hospital, and ParkwestMedical Center.That discourages many Black patients from seeking care even if they need it,said Cherokee Health’s Derrick Folsom, who helps patients enroll in healthinsurance. “Somebody knows somebody who’s getting sued for medical bills,”Folsom said. “So they stay away from medical centers.”Reflecting on her experience with medical debt, Reed said she tries to stayupbeat. “I don’t sweat the small stuff,” she said. “What am I going to do againstthis hospital?”Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…15/17But, she said, she has realized one thing about the nation’s health caresystem: “It’s not designed for poor people.”Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…16/17ABOUT THIS PROJECT“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploringthe scale, impact, and causes of medical debt in America.The series draws on original polling by KFF, court records, federal data onhospital finances, contracts obtained through public records requests, data oninternational health systems, and a yearlong investigation into the financialassistance and collection policies of more than 500 hospitals across thecountry.Additional research wasconducted by the Urban Institute, which analyzedcredit bureau and other demographic data on poverty, race, and health statusfor KHN to explore where medical debt is concentrated in the U.S. and whatfactors are associated with high debt levels.The JPMorgan Chase Instituteanalyzed records from a sampling of Chasecredit card holders to look at how customers’ balances may be affected bymajor medical expenses. And the CED Project, a Denver nonprofit, workedwith KHN on a survey of its clients to explore links between medical debt andhousing instability.KHN journalists worked with KFF public opinion researchers to design andanalyze the “KFF Health Care Debt Survey.” The survey was conducted Feb.25 through March 20, 2022, online and via telephone, in English and Spanish,among a nationally representative sample of 2,375 U.S. adults, including 1,292adults with current health care debt and 382 adults who had health care debt inthe past five years. The margin of sampling error is plus or minus 3 percentagepoints for the full sample and 3 percentage points for those with current debt.For results based on subgroups, the margin of sampling error may be higher.Reporters from KHN and NPR also conducted hundreds of interviews withpatients across the country; spoke with physicians, health industry leaders,consumer advocates, debt lawyers, and researchers; and reviewed scores ofstudies and surveys about medical debt.Stay informed.Sign up for our free daily news email.
6/2/23, 10:16 PMKnoxville’s Black Community Endured Deeply Rooted Racism. Now There Is Medical Debt. | KFF Health Newshttps://kffhealthnews.org/news/article/knoxville-tennessee-medical-debt-racial-disparities/?utm_campaign=KHN%3A Daily Health Policy Report&utm_medium=e…17/17Noam N. Levey: nlevey@kff.org, @NoamLeveyRELATED TOPICSHEALTH CARE COSTSMULTIMEDIARACE AND HEALTHSTATESAUDIODIAGNOSIS: DEBTDISPARITIESINVESTIGATIONTENNESSEECONTACT US SUBMIT A STORY TIPStay informed.Sign up for our free daily news email.