4/12/10 Brittiny Peters never imagined she would log on to eBay to sell almost all of her family’s possessions. But that's exactly what 28-year-old, stay-at-home mom from Gainesville, Ga., ended up doing earlier this year when she found herself burdened by thousands of dollars of medical debt.

Her 7-year-old daughter, Ayla, has Still’s disease, also known as systemic-onset juvenile rheumatoid arthritis, characterized by painful joints, spiking fevers and skin rashes. To add to their difficulties, her 2-year old son, Noah, has severe autism.

Brittiny and her husband Gregg, a self-employed tennis instructor, had already hired a budget coach, traded their cars for older models and pared down their cable and phone bills. Gregg cut his hours so his income was low enough for the children to qualify for Medicaid, but the government program doesn't cover all bills, and they faced medical expenses of $2,000 a month.

Selling their home wasn't an option: Even after putting down $10,000 and paying monthly mortgage payments for nearly five years, the dwindling housing market had left them with $20,000 in negative equity.

“For weeks, we asked ourselves: “What do we want to hold on to? What do we want to let go of?” says Peters. “And then it hit us. What kind of parents are we? Do we really want Noah to have three days of therapy, rather than five, just so we can keep the flatscreen TV?”

And so Peters complied a list and then logged on to eBay: Almost everything – from the Whirlpool Heavy Duty washing machine and the king-sized mahogany bed to the kids’ cradles and rope and swing set – was offered for $20,000.

What started as a family joke – “We owe so much money we might as well sell all our stuff” – had become a reality. When Mary Lemanski, a nurse from Springfield, N.J., who has rheumatoid arthritis (RA), psoriatic arthritis and osteoarthritis (OA), became so disabled that she could no longer work, at age 53, the cost of her health insurance soared.

When her premiums topped $1,000 a month, she says she could no longer pay for coverage or for the expensive biologic drug that she calls “my miracle.”

“I am even considering selling my car so I could go back on Enbrel. It was so wonderful feeling that well,” Lemanski writes in a letter to Arthritis Today. “RA is a disease only for the wealthy.”

There’s no question that arthritis is an expensive disease. In fact, osteoarthritis and other non-traumatic joint diseases consistently rank among the top ten most expensive chronic diseases according to the Department of Health and Human Services.

But now, to add to the pain of high prices, costs are shifting. Individuals like Lemanski are being asked to pick up greater percentages of the cost of their health care – a trend that shows up in higher co-pays at the pharmacy and doctor’s office and higher monthly insurance premiums.

And studies show that out-of-pocket costs are rising faster for arthritis than they are for many other chronic diseases.

In a study published in the August 2008 issue of Arthritis & Rheumatism, economists looked at out-of-pocket medical expenditures in Medicare-aged adults with arthritis, and compared them to the out-of-pocket expenses of their peers who had diabetes and heart disease. Out-of-pocket expenses for arthritis averaged yearly growth of 7.3 percent from 1998 to 2004, while annual expenses for diabetes grew by an average of only 5.8 percent over that same time period. Economic analyses show that the biggest chunk of money spent on arthritis goes to ambulatory care – things like clinic visits to see doctors and physical therapists. The next-largest piece of the pie goes to hospital stays for procedures like joint replacements. But the third-greatest cost, and the one that is perhaps hitting patients the hardest, is prescription drug spending.

A study published in the May 2007 issue of Arthritis & Rheumatism found that spending on arthritis medications more than doubled between 1998 and 2004, years when the average income did not increase.

“A lot of the drugs can be extremely expensive,” says Edward H. Yelin, PhD, professor of medicine and health policy at the University of California, San Francisco. For someone who has RA or ankylosing spondylitis, for example, Yelin says the out-of-pocket costs for their biologic drugs can amount to 20 percent of their income.

And the problem is only getting worse as the population ages, and more people need the medications.

In 2007, the number of people taking rheumatologic drugs grew faster than any other drug class, increasing by 7.3 percent over usage in 2006, according to the latest Drug Trend Report, which is published annually by Medco Health Systems, one of the largest pharmacy benefit management companies in the United States. The high treatment rate helped rheumatologic drugs become the fourth-highest cost driver of all prescription medications in 2007, behind only diabetes medications, respiratory drugs, and cancer and transplant therapies.

“It’s a fiscal truth that a lot of people have severe economic hardship because of the costs,” Yelin says.

In 2005, Harvard researchers revealed that unwieldy medical bills contributed to nearly half of all bankruptcies filed in the United States. What was less publicized was a common diagnosis behind the debt: More than a third who were surveyed reported that orthopaedic complaints, a category that includes arthritis, had caused their physical and financial pain.

Similarly, a 2008 Harvard study found that medical bills contribute to half of all home foreclosures.

Hoping to avoid that situation, Jeffrey Herchenroder, a 48- year-old music teacher from Albany, N.Y., has put his house on the market. “I’m basically rationing my health care, and I still can’t swing it,” says Herchenroder, whose medical bills are so high he can no longer afford his mortgage.

Even though Herchenroder’s RA is causing him significantly less pain since he had both hips replaced a year ago, his $70,000 salary will not cover his son’s diabetes and asthma and his wife’s OA. Between them, he says, his family has 15 prescriptions.

“I certainly never expected to find myself in this position,” Herchenroder says. “I saw myself as a pretty responsible person financially. I still think I am.” Surprisingly, in the 2005 Harvard study, 75 percent of people who ended up declaring a medical bankruptcy had health insurance when they initially got sick.

What catches many is something Elizabeth Warren, a professor at Harvard Law School, calls a “double disaster.” Too sick to work, many wind up losing their jobs and the health insurance that came with them.

After her husband lost his job in February, Laura Burch, a 45-year-old Wichita Falls, Texas, housewife with RA, lost her health insurance and began to skip her weekly etanercept (Enbrel) shots. She says she cannot afford to pay out-of-pocket costs – $1,500 a month – for the injections. Without them, she suffers from severe fatigue and debilitating pain.

“Basically, I can’t do much of anything,” she says. “Even the simplest chores fall by the wayside.”

Soon, the Burches hope to obtain some relief from COBRA, the Consolidated Omnibus Budget Reconciliation Act, a federal law that gives most unemployed workers the right to continue the same health insurance offered through their company policy for 18 months.

Until recently, COBRA payments were significantly higher than many employer-backed health-care plans. Now, however, money in the stimulus package will cover 65 percent of the cost of COBRA payments for eligible involuntarily terminated workers between Sept. 1, 2008 and Dec. 31, 2009.

Even with the help, Burch, who also suffers from Sjögren’s syndrome and depression, says she and her husband, who has a heart condition, will struggle to afford their $585 monthly premium, though it would have been $1,300 without the assistance.

They’ve already maxed out their credit cards, acquiring $20,000 debt from insurance premiums and medications, and they receive at least three letters a week from collection agencies because they have $5,000 in unpaid medical bills.

“I worry a lot about where we’re going to be 10 years down the road. I feel like we’re in a no-win situation,” Burch says. Many families like the Burches survive, barely, by relying on a patchwork system of savings, state assistance and charity.

For Brittiny Peters – who received calls from media outlets such as CNN, The New York Times and “The Tyra Banks Show” after auctioning her possessions on eBay – help came in the form of a couple from Texas who bid $20,000, but only on the condition that the family keep their belongings.

Peters is grateful for the help, but says she will continue to pare down her family’s lifestyle. With a long future of medical bills ahead, the family’s worries are far from over.

The bulk of the children’s care is covered by Medicaid, but with no private insurance to cover each other, Brittiny and Gregg cannot afford to get ill.

Last year, Brittiny’s appendix ruptured in the middle of the night, leaving medical bills of more than $20,000. “We don’t take anything for granted anymore,” Peters said. “The slightest unplanned medical emergency could be catastrophic for our finances.”