By the time he went to the emergency room, Willie Lasley's knee was "really big and red and hot."
Though he'd complained of pain in the leg where he'd had a knee replaced four years earlier, Lasley had put off seeking treatment. On Feb. 10, 2018, he had no choice, said his wife, Sheila. "His breathing was off. His heart rate was crazy."
Sepsis and meningitis kept Lasley, 58, in a Jonesboro hospital and then a long-term care facility until April 9. Since then, he's dealt with the aftereffects of his illness -- including a pile of medical bills.
Although the Lasleys had Medicare and private insurance coverage and recently were approved for Medicaid, Sheila, 69, estimates they've spent about $15,000 out of pocket between bills, co-pays, and supplies and services that aren't covered -- such as payments on a hospital-style bed for their house, Dakin's solution to treat bedsores and wheelchair transport services.
So she was inclined to accept when a former co-worker, Michele Polk-Welman, proposed a GoFundMe campaign that raised about $800 to help the couple catch up on medical expenses.
"[Without it] we would have been getting by, that was it. I'd just be paying five dollars here and five dollars there, and that's how it'd be," she said. "There's always another bill for something."
According to a National Center for Health Statistics report, more than 43 million Americans younger than 65 reported having trouble paying medical bills in the first six months of 2017. Some are turning to crowdfunding platforms, such as GoFundMe, or websites that allow users to solicit donations from friends and strangers to fill in the gaps.
On the crowdfunding website Plumfund, the largest category is now "medical and hardship," with more than 14,000 campaigns requesting assistance. (The next-largest category is "birthday," with around 4,600 campaigns.) A spokesman for GoFundMe said that in 2017, one-third of the money raised on the site went to campaigns tagged "medical" in what company CEO Rob Solomon has framed as a sign of a strained health care system.
"It saddens me that this is a reality. ... Even patients who have insurance and supposedly decent insurance [come up short]," Solomon told Kaiser Health News. "We've become an indispensable institution, indispensable technology and indispensable platform for anyone who finds themselves needing help because there just isn't adequate coverage or assistance."
Spokesmen from several central Arkansas hospitals said they hadn't heard many reports of use of crowdfunding to pay for health care, and GoFundMe and Plumfund didn't offer or didn't respond to requests for state-level data.
But multiple medical campaigns in each of the state's 10 largest cities were visible on crowdfunding websites: a Springdale man who needs money for rehabilitative equipment after a serious bike accident; a Pine Bluff woman asking for help paying for stem-cell therapy for multiple sclerosis.
Arkansans who looked to crowdfunding to help with expenses in health emergencies describe a complex mix of emotions.
While most said they were grateful that the services exist and expressed surprise at the generosity of their communities, they said changes to address health costs -- which reached $10,739 per person per year in the United States in 2017, according to the Centers for Medicare and Medicaid Services -- are urgently needed.
Crowdfunding "is a Band-Aid," said Diya Patel, 28, of Conway, who started a crowdfunding campaign after her 8-year-old nephew Raj was diagnosed with cancer.
"It's not the solution to the problem, it's the solution to the symptom."
Patel's hesitance is matched by that of experts, who say a lack of oversight and the limits of the medium, such as its tendency to be less effective for people with smaller social networks, mean it's unlikely that crowdfunding will be much more than a stopgap for the health expenses some families are struggling to manage.
"I can't see this being consistently a successful way to pay for health care costs," said Dr. Joe Thompson, president and CEO of Arkansas Center for Health Improvement. "At some point, there will be a limit to the number and amount that people will give."
'IT'S REALLY KIND OF SAD'
People who talked with the newspaper about using crowdfunding during a family member's health event were largely grateful for the platforms and for financial support in tough times, but they also voiced anxieties about self-reliance and criticized the health system.
Sometimes the campaigns weren't started by those immediately affected, but by relative strangers.
James Gift, 35, of Little Rock said he wasn't totally sure who classmate Natasha Cornell was when she proposed a campaign for his wife, Melissa, who was hospitalized for months after problems related to surgery to remove a cancerous growth on her kidney.
Melissa, an assistant at a cemetery, had been the family breadwinner while Gift was in law school.
Although the specifics of their situation were dire and Gift was more concerned about rent than paying medical bills, he said he wouldn't have started a campaign on his own.
"I don't ask for help very often. ... I take care of myself, I don't ask for handouts," he said.
Patel encountered a similar perspective from Raj's father, who she said would not even accept a gift of groceries and took "a lot of convincing" to accept the idea of a campaign to raise money for help with expenses when his son got sick.
That wasn't the case for Kiana Frierson's grandmother, Debra Frierson-Verge of North Little Rock, who brought up the idea of a crowdfunding campaign to pay for treatment just as Frierson, 19, was thinking about starting one. Frierson-Verge had experienced a recurrence of breast cancer that had metastasized to her lungs, and Frierson said she hoped a campaign would help "alleviate her worries and stress."
Although she was pleased with the response to the campaign, which had raised more than $4,000 for her grandmother's treatment, she was ambivalent when asked what the popularity of such services means.
"It's a great resource to have, but I really feel like we shouldn't have to use [crowdfunding]. ... Money should not be the factor that depends whether you get to live or not," Frierson said.
"I think it's really kind of sad that it comes down to this," Cornell said. "There should be some sort of safety net, and there isn't."
One benefit that people mentioned was that crowdfunding casts a wide net for donations, attracting contributions from close family members to teachers to acquaintances on the Internet. Frierson said a lot of people who donated to her grandmother's campaign were people she knew from social media, her grandmother's friends or people who had similar cancers.
And users of campaigns said they intended to use receipts to shoulder not just immediate medical expenses but burdensome ancillary costs of illness, such as travel back and forth to hospitals.
Bethany Burney, 27, of Fayetteville, who started a campaign for friend Morgan Hill who was injured in a car accident, said Hill's family would likely use the money for that purpose, as well as for the lengthy course of physical therapy.
Because Hill, who is also a co-worker's sister, was uninsured at the time of the crash, Burney said money raised through crowdfunding could help keep her from having to declare bankruptcy -- but she'd still prefer a system in which the platforms were mostly used to support help with traveling, school expense or mission trips.
"I wish we were in the position where it didn't have to be" like health insurance, she said.
While broadly critical of high health costs, most said they weren't sure what, if any, specific policy changes they'd like to see to address the issue.
Gift said that while he was thankful for insurance and Patient Protection and Affordable Care Act changes such as the elimination of lifetime limits on coverage -- a law the Department of Justice recently moved to have invalidated in appellate court -- his wife's health insurance premium eats up between 20 percent and 30 percent of her paycheck, and he'd be interested in the possibility of expanding Medicare programs.
Patel was less optimistic about the possibility of changes.
"Absolutely not, I have no hope for that," she said. "The problem is so big, and I don't see a solution, or somebody coming up with a solution."
COST BURDEN
Almost half of Americans surveyed in a November Gallup poll said they were worried about having enough money to pay for health care, with 66 percent of people who make less than $30,000 saying health expenses were a "major concern."
As a way to manage those pressures, Thompson sees crowdfunding services as a "more extreme version" of arrangements like health sharing ministries, in which members of a faith-based organization contribute to one another's bills.
Health policy observers and academics are divided on how much benefit crowdfunding can provide.
In one paper, University of Minnesota researchers found that crowdfunding helped prevent 114-136 medical bankruptcies per quarter in the United States. Other studies fault the platforms for exacerbating existing inequities, skewing in favor of people who are technology- or media-savvy or with broad social networks -- in other words, people who may already be doing better financially.
Thompson said his primary concerns about crowdfunding in the health care arena include few protections for donors, who can't be assured that their donations will actually support medical expenses, and the platforms' potential lack of utility for chronic conditions, which make up the bulk of health costs but don't provide the sorts of narratives that inspire donations.
About 75 percent of health care spending goes to treatment of chronic illnesses such as heart disease or diabetes, according to the Centers for Disease Control and Prevention.
For patients, Thompson said the underlying problem is that "[after the Affordable Care Act went into effect], we did not move far enough on cost containment."
The rise of high-deductible health insurance plans, policy changes such as the elimination of the tax penalty for not carrying health insurance and a high cost of care have left many with significant financial exposure during illness or injury.
It's not helped by market consolidation in many metropolitan areas -- in which hospitals or health care systems acquire one another -- and "unsustainable" prescription drug costs, argues health consumer advocacy group Families USA executive director Frederick Isasi.
He said one fix to limit costs for individuals lies in tighter regulations for insurance markets, pointing to recent changes that have allowed insurers to sell plans that provide minimal coverage amid what he says is widespread agreement that health insurance should provide a buffer against unmanageable expenses.
"You've got to make sure that if people pay their premiums, they're getting real coverage ... [Families] want to know that everything they worked for their whole life they [won't] lose just because they get sick or their kid gets sick," he said.
Thompson added, "We must figure out a way to spread health care risk -- however we want to finance it -- so that one individual doesn't feel the effects of their unanticipated event."
'ONE BILL AWAY'
In one case in Arkansas, a provider is using crowdfunding not to pay for health care but to provide it.
Larry Freeman, an insurance-industry professional who served on a state emergency medical advisory board under Gov. Mike Huckabee, has been running a crowdfunding campaign to pay for "Synergy Saturday," a nonprofit pop-up event to provide free health screenings in Arkansas communities.
"I had an idea that was definitely bigger than my pocketbook, but I wanted to start it anyway," he said.
The pop-up events emphasize prevention by becoming aware of one's health status through metrics such as one's blood pressure or blood sugar.
While he also raises money through Facebook and on a website, he said he was attracted to crowdfunding because of its popularity, meaning he didn't have to explain it to people. Money he raised on the platform goes toward vehicle maintenance -- the program has a decommissioned ambulance to help with services -- and screening supplies such as glucometers.
Freeman hopes services like his will help defray health care costs for individuals. He said screenings can avert costly emergency room visits, get people on medication before a health crisis and direct them to doctors' offices for expense-saving preventive care.
He saw the popularity of crowdfunding in health care as indicative of consumers' difficulties in that industry.
"It's quite evident that we need to do something in America to change health care and the affordability of it," he said. "People have to go to crowdfunding to afford their basic health care needs ... they're one bill away from bankruptcy."
SundayMonday on 03/31/2019