At a health-screening event in Sarasota, Florida, people milled around a parking lot waiting their turn for blood pressure or diabetes checks. The event was held in Sarasota's Newtown neighborhood, a historically Black community.
Local resident Tracy Green, 54, joined the line outside a pink and white bus offering free mammograms.
"It's a blessing, because some people, like me, are not fortunate and so this is what I needed," she said.
Green said she wanted the exam because cancer runs in her family. And there's another health concern: her breasts are large and cause her severe back pain. A doctor once recommended she get reduction surgery, she said, but she's uninsured and can't afford it.
In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.
A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor's office visits. Many didn't take medications as prescribed.
The neighborhood screening event in Newtown — organized by the non-profit Multicultural Health Institute in partnership with a local hospital and other health groups — is part of an effort to fill in the coverage gap for low-income people.
Tracy Green explained that her teeth are in bad shape too, but dental care will also have to wait. She doesn't have health insurance or a stable job. When she can, she finds occasional work as a day laborer through a local temp office.
"I only make like $60 or $70-something a day. You know that ain't making no money," said Green. "And some days you go in and they don't have work."
If she lived in another state, Green might have been able to enroll in Medicaid. But Florida is one of eleven remaining states that haven't expanded the program to cover more working-age adults. With rent and other bills to pay, Green says her health is taking a backseat.
"I don't have money to go to the dentist, nothing, it's so expensive," she said. "Now, to get one extraction, one tooth pulled, it's like $200-300 that you don't have. So I don't know what to do. It's like fighting a losing battle right now."
In the Kaiser poll, 85 percent of uninsured adults said they found it difficult to pay for health care. Nearly half of insured respondents said they struggled with affordability as well.
The U.S. experienced record high inflation rates last year, and parts of Florida, including the nearby Tampa metro area, often fared even worse.
"We see an increasing desperation," said Dr. Lisa Merritt, executive director of the Multicultural Health Institute.
The Institute, which helps people access low-cost care, is based in Newtown. The neighborhood, inland from Sarasota's lavish beach communities, has many residents who live below the poverty line, lack insurance and face other barriers to consistent and affordable care.
"It's very difficult for people to be concerned about abstract things like getting screenings, getting regular health maintenance, when they're contending with the challenges of basic survival: food, shelter, transportation often," Merritt said.
'Horrible' housing costs put squeeze on health needs
Merritt and her team of volunteers work to build trust with community residents who may not be aware that support is available. They help people apply for low-cost insurance coverage, free medication programs and other resources that can reduce treatment costs.
Volunteer Bonnie Hardy said the people she serves have many financial worries, but one thing tops the list.
"Right now? A place to stay," said Hardy. "Housing is horrible."
High housing costs have started to ease in recent months, but data shows rent in Sarasota has gone up nearly 50 percent since the pandemic began in 2020.
Hardy helps people find housing and connects them with programs that cover costs like utilities and security deposits. The goal is to help people stabilize their day-to-day lives, and that in itself can improve health, she said.
"Because they're more comfortable now," she said. "They feel like, hey the rent is paid, I can let my guard down, maybe I can go get the medical attention I need."
Research shows putting off health care can lead to bigger problems.
The Gallup poll found 27% of respondents delayed treatment due to costs even for "very or somewhat serious" conditions.
Another reason people may be holding off on treating medical issues is that they already have health care debt. An investigation from NPR and Kaiser Health News found about 100 million people in America had medical debt. About 1 in 8 owe more than $10,000, according to a KFF poll.
Treating cancers or chronic conditions like diabetes early can not only save lives, it can also be less expensive than treating advanced-stage illnesses, according to the Centers for Disease Control and Prevention.
Doctors at the health screening event in Newtown said it's critical to help residents access preventive care.
At the health fair, substitute teacher Crystal Clyburn, 51, got a mammogram on the pink-and-white mobile bus and had her blood pressure checked. Clyburn doesn't have health insurance and she relies on events like this to stay on top of her health.
"I just try to take advantage of whatever that's out there, whatever that's free," she said. "You have to take care of yourself because you can look healthy and not even know you're sick."
After the cuff came off, a doctor told Clyburn her blood pressure was a little high. But then the doctor kept talking, and she smiled.
Although her pressure was high, it wasn't high enough that she needed to take medication. She thanked him and left, relieved to know that was one expense she wouldn't have to worry about. Not yet, anyway.
This story comes from NPR's health reporting partnership with Kaiser Health News (KHN) and WUSF.
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