Cassenda Nelson, a community healthcare worker in Camilla, Georgia, braces herself with each ring of the phone, fearing news of another unpaid medical bill for her daughter, Amunet. The 16-year-old requires constant care for type 2 diabetes and a seizure condition, leading to frequent emergency room visits and a mounting debt that Nelson estimates exceeds $10,000.
Nelson’s struggle highlights a growing crisis of medical debt in the United States, where over 100 million people are burdened by bills they cannot afford, according to a recent analysis. Despite having employer-sponsored health insurance, Nelson finds herself constantly prioritizing her daughter’s immediate medical needs over other essential expenses like groceries, rent, and even her own healthcare.
“Sometimes I can’t even buy groceries,” Nelson told Business Insider. “I make a certain amount of money, but I bring home very little because she needs to have the best insurance. When I was on other insurances, I kept getting issues with pre-authorization. I couldn’t even get my baby insulin.”
The financial strain is compounded by the fact that Nelson lives in a rural area, requiring long drives to access specialized medical care for Amunet. Her monthly health insurance premium alone costs $787. The debt has already impacted her credit score, as balances exceeding $500 can be reported to credit bureaus after a year, even though collection agencies cannot legally charge interest on medical bills.
Nelson’s situation isn’t unique. A 2024 KFF analysis of government data found that millennials and Gen X carry the most medical debt compared to other generations, and Black Americans and those in rural areas are disproportionately affected. Approximately 14% of those with medical debt owe at least $10,000.
The escalating costs have forced Nelson to make difficult choices. She has stopped contributing to her son’s college tuition, and recently, the electricity was shut off in her home due to unpaid bills. Unable to afford a caregiver, she often brings Amunet to work with her or relies on assist from her other children. The family recently moved into low-income housing after being unable to afford their previous home.
Beyond the financial burden, Nelson describes the exhaustion of navigating the healthcare system, particularly as a Black woman. She feels compelled to present a polished image even during emergencies, preparing her clothes the night before in anticipation of a potential middle-of-the-night seizure and ambulance ride. “I know that because of me being an African American woman, walk here without any clothes on my hair combed,” she said. “It shouldn’t matter, but I have to present my best self.”
Despite the overwhelming challenges, Nelson remains resolute in her commitment to Amunet’s well-being. “I don’t give up,” she said. “I get up every morning and I pray.”
