Robert Miller spent more than two decades earning a good living as a technical writer, and that’s what he expected to continue doing until he retired.
But over many of those years, Miller also struggled with a serious heart condition, for which he finally sought surgical treatment in 2008.
Miller, 58, says he now is in good physical health. But after several years of sporadic contract employment, he and his wife are in far worse financial health.
“Our household is very topply. We could go down at any point,” said Kathy Miller, Rob’s wife.
When Americans get seriously ill, most immediately think of the high costs of treating the problem itself. But for many Americans like the Millers, the economic consequences of serious illness are much deeper and last longer. That’s because the illness can leave them earning less money, or none at all, even years after the serious illness has passed.
Many researchers have long speculated that people who are poor have worse health outcomes because they have less income to get treatment.
But in fact the opposite is quite common: People who are in poor health have less money because their illness has affected their ability to work, said James Smith, chair of labor markets and demographic studies for the think tank RAND Corp.
He said the problem is especially acute for people in their late 40s to 60s, who were nearing retirement. When illness hits, they may either have to stop working or cut back, or they become less desirable to employers because of health limitations. That puts them in the awkward position of being too young for retirement benefits, Social Security and Medicare, but too old to make up lost economic ground. Because most working-age people get health insurance through work, they also may end up without health coverage at a time when it is most necessary.
“I would say one of the hardest things to happen to people is getting sick too young,” Smith said.
Early in life, Smith said the most important things are choosing the right career and finding the right spouse or partner. But after about age 45, he said, “the one thing is you wish (for yourself) is not to get sick.”
The Affordable Care Act passed under the Obama administration will help alleviate one issue for people in these circumstances, if it stays in effect. That’s because it will give them access to less expensive health coverage despite their pricey pre-existing conditions.
Those provisions of the health care act are scheduled to take effect in 2014, but they could be delayed or defunded if Mitt Romney beats Barack Obama in the presidential election next month.
But for many people, the core financial worry isn’t getting health insurance. It’s drawing a paycheck.
Danny Wilcox Frazier / for NBC News
Robert and Kathy Miller, shown in front of their home, have struggled financially since Robert had heart surgery.
Miller first learned about his heart condition, called hypertrophic cardiomyopathy, in 1994, when he fainted unexpectedly while leaving a basketball game with his son.
For years after his diagnosis, he took medication and had regular check-ups but didn’t get any further treatment, even though the condition worsened.
By the mid-2000s, Miller said even light activity was difficult for him.
“I had trouble even walking from my desk to a meeting or walking out to the car, and I was really, really concerned about that and distracted at work,” he said.
At the time, Miller was working for a big bank. He said his boss was very supportive and encouraged him to get surgery to treat his heart problem.
In the fall of 2008, Miller traveled from his home in West Des Moines, Iowa, to Cleveland to have the surgery. The bill was mostly covered by his insurance through work.
His rehabilitation was lengthy, and he suffered at least one stroke and additional heart complications. He still wasn’t cleared by his doctor to return to work even after he’d exhausted his short- and long-term disability.
“I wanted to follow his advice,” Miller said.
So in 2009 Miller let the bank lay him off. He figured he’d collect unemployment until he was recovered and then find another job. He’d changed jobs in the past and said he’d never had trouble landing one that paid more.
But this time, Miller had no such luck. He’s had several contract jobs over the past few years, with stints of unemployment in between. His current contract, which he landed after eight months of unemployment, is scheduled to finish up at the end of this year.
Miller said he still occasionally has trouble concentrating but mostly feels healthy and ready for full-time, permanent work.
He and his wife, a self-employed website designer, expect to earn about $50,000 this year, compared with about $80,000 five years ago.
They filed for bankruptcy in 2011 to deal with high credit card debt and other bills. They also liquidated their retirement savings in an attempt to start a small business distributing sports paraphernalia to convenience stores, but it hasn’t been as profitable as they’d hoped.
They have managed to hang on to their house so far, but are increasingly worried they could be forced to sell it.
Because his employment has been sporadic and temporary, Miller hasn’t always had health insurance. He wasn’t insured last January when he woke up in the middle of the night with terrible stomach pain.
He went to the emergency room and found out it wasn’t serious, but he still ended up with an $8,700 bill that he’s working to pay off.
The couple otherwise has not sought much treatment for health concerns.
“Really, we have not gone to a doctor in the past couple of years,” Miller said.
Nicole Maestas, a senior economist with RAND, said it’s all too common for people who have major health problems before retirement age to face a period without insurance. That’s because they don’t have a job with benefits and can’t afford coverage on the open market.
“You lose the coverage just when you most need it,” she said.
Francine Gingrich has been able to get health insurance through her husband’s job as an aircraft mechanic, but it’s cost them thousands of dollars a year. In addition, the approximately $38,000 he makes annually hasn’t been enough to keep the couple from flirting with bankruptcy.
Gingrich, 58, worked for 17 years as a workers compensation adjuster, making about $65,000 a year. She also suffers from a heart problem, called a left bundle branch block, which sometimes makes it harder for blood to pump efficiently.
The stress of the job, combined with her heart problem, was so severe that she began to worry it would literally kill her.
“I was totally exhausted to the point where when I came home from work I was in tears, every day,” she said. “I couldn’t even put two sentences together.”
In late 2008, she quit her job with the intention of taking some time off and then finding something that was less stressful. After a few months, she began working temporary and part-time jobs in the insurance field, allowing the couple to earn enough to get by
But by 2011, that type of work became harder to find and she hasn’t been able to make very much money since.
“We don’t have enough money to keep up with the cost of living,” she said.
To cover medical expenses and other bills, the couple has relied on their credit cards and now has about $40,000 in credit card debt.
“Honestly, I think it’s only a matter of a couple of months, if that, and we’ll have to file for bankruptcy,” she said.
The Americans with Disabilities Act does require employers to make reasonable accommodation for employees with disabilities. But Maestas’ research has shown that workers with severe health problems should not necessarily expect to get much accommodation from an employer while dealing with an illness.
Maestas said her analysis of data on health and retirement has found that only about one in five people who experience a work-limiting health problem later in their careers will get some sort of accommodation, such as a more flexible schedule.
Many will end up out of work. Maestas said her research also has shown that within one or two years, only 55 percent of those people who were working when they had a work-limiting health problem are still working.
The data is still being reviewed, she said, and it’s not yet clear whether those people chose to stop working or are involuntarily out of work.
Maestas expects things to get better in decades to come, as the population ages and employers find they are in greater need of workers who are older and need accommodation. Still, she acknowledged that it’s hard to see that big picture now, when the job market is so difficult.
Kathy Miller, 63, said she has never regretted her husband’s decision to get his heart surgery, even though it has led to such serious economic hardship.
“I’ve never been sorry because now he’s normal. He can walk fast, he can go out and work in the yard and he can enjoy it,” Miller said. “I’d say he was back to normal now, and I think he could be hired for a full-time job.”