The Canos are amongthe 1 in 4 Americans who report in multiple polls that the highcost of health care is the biggest concern facing their families.(Photo: Shutterstock)

Robert and Tiffany Cano of San Tan Valley, Ariz., have a newmarriage, a new house and a 10-month-old son, Brody, who isdelighted by his ability to blow raspberries.

They also have a stack of medical bills that threatens toundermine it all.

In the months since their sturdy, brown-eyed boy was born, theCanos have acquired more than $12,000 in medical debt — so much that they need aspreadsheet to track what they owe to hospitals and doctors.

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“I'm on these payment arrangements that are killing us,” saidTiffany Cano, 37, who has spent her lunch hours on the phonenegotiating payoff plans that now total $700 a month. “My husbandis working four jobs. I work full time. We're a hardworking familydoing our best and not getting anywhere.”

The pair, who earn nearly $100,000 a year, are insured and havehad no major illnesses or injuries. Still, the Canos are among the1 in 4 Americans who report in multiple polls that the high cost of health care is the biggestconcern facing their families. And they're at risk of joining the62 percent of people who file for bankruptcy tied to medicalbills.

“Oh, yes, that worry is always in the back of my mind,” Tiffanysaid.

The family is part of a struggling group: middle-class folks whohave followed the rules and paid for employer-based medicalinsurance, only to find that soaring health care costs — combinedwith high deductibles, high copayments and surprise medical bills —leave them vulnerable.

“I thought we'd be covered, and it's just not enough coverage atall,” she said.

Robert Cano, also 37, had family health insurance for 2018through his job as a manager at a large-chain retail store, forwhich he pays nearly $500 per month. The plan's $3,000 annualdeductible and 40 percent coinsurance fees have added up fasterthan the Canos anticipated.

First came the nearly $4,000 bill from the in-network hospitalwhere Brody was born Jan. 2, followed by separate fees from theanesthesiologist and the doctor who performed the routine delivery.Then, at 2 months, Brody was hospitalized with breathing problemsdoctors said could be related to allergies or asthma. In May,Tiffany came down with a stomach virus that sent her to theemergency room for drugs to treat nausea and dehydration. InOctober, the baby developed a bad case of bacterial conjunctivitis,or pinkeye.

“It's been, like, $300 here, $700 there,” said Tiffany. “We hada hospital bill for him being sick of, like, $1,800.” Unableinitially to find a pediatrician she liked, Tiffany has agonizedover whether to use the ER when Brody gets sick. When he hadpinkeye, she debated whether to take him in, hoping it would getbetter on its own.

Then he got worse, she said, pulling up a photo on her phone ofher son with half-moons of red, puffy flesh under his darkeyes.

“I let him suffer for a day like that,” she said.

The Canos lost their first child, a girl, midway through herpregnancy in 2016. Tiffany acknowledges that experience has lefther more anxious than the average first-time mom.

“It gave me so much fear that something would happen to him,”she said.

As for their own health care needs, the couple put themselveslower on the priority list. Tiffany has used a prosthetic limbsince childhood, when her lower left leg was amputated because of abirth defect.

She needs a new prosthesis because her body changed duringpregnancy, but she can't see how to afford it.

A model suitable for the busy life of a working mom would easilycost $10,000 to $15,000, according to Tom Fise, executive directorof the American Orthotic & Prosthetic Association.

“I try to push through,” Tiffany said. “I put on that brave faceof just walking, but it's so painful to walk. I have bruises allover my leg. I get blisters all the time.” Lately, she's beenwearing an old prosthesis, one she used in high school, becauseit's more comfortable.

The Canos don't know how exactly they fell into such debt, sincethey tried hard to make responsible decisions. After meeting threeyears ago, they knew quickly that they wanted to marry and have afamily.

“I waited until I found the right guy,” said Tiffany, who wasthrilled when, in 2016, they were able to afford a2,500-square-foot, two-story home in one of the stucco-and-tileneighborhoods an hour outside Phoenix.

But, taken together, the medical payment plans and premiums arealmost as much as their $1,300 monthly mortgage. All told, theCanos spend about 15 percent of their annual income on health care,almost three times the average for non-Medicare households inthe U.S.

That leaves too little for day care, car payments, gas, food anddozens of other domestic expenses, Tiffany said.

For 17 years, Robert Cano had comprehensive health insurancethrough his job as a soldier in the Army Reserve and paid little ornothing for medical care. He left the Army in 2017, however, afterhe learned he would be deployed for an extended time away from hiswife and new son.

“I told them, 'I have to be at home,'” he recalled. The Armyinsurance ended on Dec. 31, 2017, two days before Brody wasborn.

That meant moving to his employer's insurance plan. Like morethan 40 percent of 152 million Americans who get health insurance through work,the Canos are enrolled in a plan that demands thousands of dollarsbefore any coverage kicks in.

The couple discovered that they earn too much to qualify forfinancial assistance from medical providers, or for subsidies ifthey shifted their insurance to a plan under the federal healthinsurance exchange. She is a full-time bank compliance officer. Heis a full-time store manager.

Tiffany wrote to KHN after seeing stories about sky-high medicalbills on TV. Dr. Merrit Quarum, the chief executive of WellRithms, a health careconsulting firm, reviewed the family's medical bills and theresponses from their health care providers.

Though Quarum had questions about some of the fees in theitemized bills — $4 for a 600-milligram ibuprofen tablet? $3,125 toplace an epidural? — he found the charges were legitimate under theterms of the contract between the hospital and the Canos' insurer.Tiffany's only recourse was to set up the five payment plans shenavigates each month.

“I wish I could say it wasn't so, but it is,” Quarum said.

Mostly to pay off that health care debt, Robert has takenseveral part-time gigs this year — he works as a substitute teacherand a nighttime security guard and delivers sandwiches for afast-food chain in Scottsdale, 40 miles away, where tips arebetter. He said he sometimes works up to 120 hours in a week.

“I'm not ashamed or embarrassed, even as old as I am, to deliversandwiches,” he said, pulling on his retail chain polo shirt beforerushing to a Saturday morning shift.

He continued: “I know people, they'd rather get food stamps andfeel sorry for themselves. But I'm a fighter. I will not give up. …If I can bring in an extra $400 a week or $800 a month, she can getwhat she needs for the baby.”

Often getting home after midnight, he keeps shampoo and shavingcream in his car and naps in parking lots between jobs, relying onRed Bull and aspirin to stay alert.

That means on many nights, when Tiffany picks up Brody from daycare after her 90-minute commute, she handles most of the chores athome.

“Sometimes I feel like a single mom because my husband is neveraround,” she said.

She carefully tracks the family's medical expenses, trying tojuggle them with ordinary outlays that can't wait — like $500 forthe brakes that went out on her car this month.

At the rate they're going, the bills won't be paid until Brodyis 3, Tiffany said. The Canos are getting older and they'd like tohave another baby before it's too late, but, for now, that seemsimpossible.

For 2019, the couple have decided to switch to a different planoffered through the regional bank where Tiffany works. The premiumis higher — $650 a month — but the deductible is $1,500 with just10 percent coinsurance.

“It is going to be a lot more per paycheck, which is going tohurt us,” Tiffany said. “But after what just happened, I want tomake sure we are prepared in case anything does occur.”

How to fix a health care system that burdens middle-classfamilies so heavily is beyond her, she said.

“The only thing we can do is just keep working,” Tiffany said.“I always wonder: How does everybody else do it?”

KHN's coverage of children's health care issues is supportedin part by the Heising-SimonsFoundation.

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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