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For years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released this money by the Centers for Disease Control and Prevention. Still, that survey shows 20 percent of Americans still face hardships because of medical costs. And the hardest hit: African-Americans. NPR's Patti Neighmond brings us some of their stories in our series The View From Black America.

PATTI NEIGHMOND, BYLINE: Mike Jackson is 52 years old. He lives in Oklahoma City and works for a major insurance company.

MIKE JACKSON: I have high blood pressure, hypertension and I also have diabetes. I have been diabetic now for 15 years.

NEIGHMOND: Treating these chronic health problems isn't cheap. Jackson's bills add up to nearly $500 a month.

JACKSON: Diabetes alone - just the two medications alone for diabetes would have run $325 a month.

NEIGHMOND: Would have, because Jackson couldn't pay. This time last year, he was laid off, got divorced and lost his health benefits. He worried he may not be able to afford the insulin he needs to control his diabetes. So, he started reducing what he took to try to make it last.

JACKSON: So, instead of taking 60 units twice a day I was taking 30 units twice a day. And the idea behind that was if I watched what I would eat and then stay with the 30 units, I would keep my blood sugar down enough that hopefully it would not, you know, be much of a problem.

NEIGHMOND: We heard similar concerns about the cost of prescription drugs from African-Americans in a poll NPR recently conducted with the Robert Wood Johnson Foundation and the Harvard School of Public Health. One in four African-Americans said they had problems paying for needed medications over the past year. For Jackson, eight months of inadequate insulin had consequences. He developed numbness in his foot and toes, and nerve damage in his eye - both complications of uncontrolled diabetes.

JACKSON: My left eye actually shut; it wouldn't open. The muscle for my eyelid won't open.

NEIGHMOND: An ophthalmologist gave Jackson a discount but he's still struggling to make payments. In our poll, one in three African-Americans said they too had serious problems paying for doctor of hospital bills in the past year. To find out more about what effect this might be having on people's health, NPR put out a call on Facebook. Thirty-year-old Ashley Liggins responded. She lives in Fort Worth, Texas, and works full-time in finance, a job with benefits. But, she says, she'll never forget not having health insurance and the hard choices she had to make.

ASHLEY LIGGINS: At the end of the day, it was either put gas in the car - my very expensive commute - or go to the doctor. So, I kind of always had to make that very critical decision. And at the end of the day, I needed a job in order to get the benefits so the job always won out.

NEIGHMOND: Liggins has high blood pressure - it runs in her family. She also tried to stretch out her medication.

LIGGINS: Maybe skip a couple of days - skip a day here, skip a day there, only drink water, watch what I eat, like, excessively so that I'm not, like, running up my pressure. If I did eat a little crazy one day, take the medicine that day.

NEIGHMOND: For Liggins, too, there were health consequences: she got headaches, just didn't feel well, and when she took her blood pressure, she says, it was really high. A single mother of two young children also wrote to us. She told us about being sued by three collection agencies for unpaid medical bills about $5,000. She has no idea how she'll pay. She also has high blood pressure, a common worry among African-Americans in our poll. Robert Blendon is a professor of health policy at the Harvard School of Public Health.

ROBERT BLENDON: Here, we specifically asked African-American families what were the top concerns they had for health in their own family. And we ended up with high blood pressure, stroke and diabetes as being the top. And in other national surveys, cancer and other type of illnesses are often raised as the national concern.

NEIGHMOND: And even though most of those polled actually had health insurance either private or public, nearly half said they still worried that if they suffered a major illness in the future they wouldn't be able to pay for medical care.

BLENDON: We found general economic insecurity among families who generally were doing well. And this fear of paying a larger medical bill was just one of the top problems they had. And clearly, that is in people's lives as something that really worries them on a day-to-day basis.

NEIGHMOND: For Mike Jackson, a day doesn't pass when he doesn't think about what could happen.

JACKSON: It's one of those things where, you know, if something happens to my car or to me health-wise, I'm in trouble. If I have to go to the hospital, like I did for my eye, it's one of those things if I slip, if there's any slippage anywhere something goes wrong, I'm one step away from disaster.

NEIGHMOND: So, every day, more often than once, Jackson checks the Internet and newspapers searching for a permanent job with benefits. Patti Neighmond, NPR News.

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