This is a newer research topic for me – I’m examining the link between job loss and mental health during COVID-19, use of a “fintech” credit product to help workers with medical debt, and the effects of the Child Tax Credit on healthcare utilization among children and parents. Financial determinants will be a pretty important part of my most recent project on precarious employment.

My prior work in healthcare access

Before joining academia, I worked on access to health care among lower-income individuals, including work with a free clinic, HIV care coordination, and pro bono specialty care networks. Currently, I am developing proposals and projects that blend my past work on access to care with my current focus on financial wellbeing. Poverty is strongly correlated with poor health outcomes, yet it’s important to understand what specific structural factors are creating financial barriers that negatively affect access to health care and increase risk for poor health outcomes.

Why is this a problem? Because prior research shows that about a quarter of Americans have trouble paying for medical expenses (much higher among Black Americans) and half say they skip needed care due to costs. Delayed care increases risk for poor health outcomes, including death and cancer death specifically.

Thus, I am keenly interested in “upstream” drivers of medical debt and the (un)manageability of health care expenses for low- and moderate-income people, including the role of hospitals’ charity care program performance (spoiler alert: it’s not a pretty picture), difficulties covering out-of-pocket (OOP) expenses while in deductible periods (especially for frontline workers who have high deductible health plans and whose employers do not pay into Health Savings Accounts), and consumers’ confusion about copayments, coinsurance, deductibles, and premiums – which together represent consumers’ cost share.

The U.S. spends far more on health care per capita than other advanced economies yet gets mediocre outcomes and consumers have to shoulder too great a financial risk – part of a general neo-liberal economic trend of the past 40 years that places too much faith in markets to promote quality of life.